[1]常晓,张保中,翁习生,等.高龄髋部骨折术后院内死亡的危险因素分析[J].中华老年骨科与康复电子杂志,2017,(01):43-49.[doi:10.3877/cma.j.issn.2096-0263.2017.01.009]
　Chang Xiao,ZhangBaozhong,WengXisheng,et al.Risk factor analysis for postoperative mortality in hospital of geriatric hip fracture patients[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2017,(01):43-49.[doi:10.3877/cma.j.issn.2096-0263.2017.01.009]
点击复制

高龄髋部骨折术后院内死亡的危险因素分析()
分享到：

中华老年骨科与康复电子杂志[ISSN:1674-3911/CN:11-9292/R]

卷:
期数:
2017年01期
页码:
43-49
栏目:
论著
出版日期:
2017-02-05

文章信息/Info

Title:
Risk factor analysis for postoperative mortality in hospital of geriatric hip fracture patients
作者:
常晓; 张保中; 翁习生; 林进; 张万利; 金今; 张嘉; 钱文伟; 高鹏; 邹雄飞; 唐璜
100730 北京协和医院骨科
Author(s):
Chang Xiao;  ZhangBaozhong; WengXisheng; Lin Jin; ZhangWanli;  Jin Jin; Zhang Jia; QianWen wei; Gao Peng; ZouXiongfei;  TangHuang
Department of Orthopaedics, Peking Union Medical College Hospital, Beijing 100730, China
关键词:
髋骨折;  院内死亡率;  高龄;  危险因素
Keywords:
Hip fractures;  Hospital mortality;  Aged;  Risk factor
DOI:
10.3877/cma.j.issn.2096-0263.2017.01.009
文献标志码:
A
摘要:
目的 探讨高龄髋部骨折患者术后院内死亡的危险因素。方法 回顾性分析 2004年 1月至 2014年 12月于北京协和医院骨科接受手术治疗且符合纳入标准的高龄髋部骨折患者 480例（股骨颈骨折 325例，股骨转子间骨折 155例）。以术后结局（生存或院内死亡）为因变量，以性别、年龄、骨折类型、ASA评分、麻醉方式、手术方式等为自变量。其中院内死亡共计 13例，作为死亡组；随机选取 42例正常出院、术后生存期超过 90 d的患者作为对照（生存组）。采用多因素 Logistic回归分析引起术后院内死亡的危险因素。结果 肺部感染和急性心梗是高龄髋部骨折患者院内死亡的主要直接原因，院内死亡率为 2.71%。单因素分析示组间年龄（t=2.623，P＜0.05）、合并症数目（c2=6.302，P＜0.05）与吸烟史（c2=6.061，P＜0.05）差异有统计学意义；多因素 Logistic 回归分析示年龄（Wald=5.209，P＜0.05， OR=0.757）、合 并 症 超 过 2 种（Wald=4.915，P＜0.05，OR=0.155）和 吸 烟 史（Wald=6.853，P＜0.05， OR=10.917）为导致患者院内死亡的独立危险因素。结论 高龄髋部骨折患者术后肺部感染与心梗的风险较高，在治疗过程中不可忽视年龄因素，对于有吸烟史的患者要尤其关注。
Abstract:
Objective To analyze the risk factors of postoperative in-hospital death in elderly hip fracture patients. Methods Four hundred and eighty patients (325 femoral neck fracture, 155 intertrochanteric fracture) treated in Peking Union Medical College Hospital from January 2004 to December 2014 were included in this retrospective study. Survival or in-hospital deaths (postoperative outcome) was chosen as the dependent variable, and gender, age, fracture type, ASA score, comorbidities and other parameters were tested as independent variable. Thirteen in-hospital death cases were assigned to death group. Forty-two cases survived at least 90 days postoperatively were randomly selected as control group. Multi-factor Logistic regression analysis was applied to evaluate the risk factor of postoperative in-hospital death.Results Pulmonary infection and acute myocardial infarction were two main direct causes of postoperative in- hospital death with 2.71% mortality. There was significant difference on age (t=2.623, P<0.05), comorbidities (c2=6.302, P<0.05), and smoking history (c2=6.061, P<0.05) by single factor analysis. Multi-factor Logistic regression analysis showed that age (Wald=5.209, P<0.05, OR=0.757), more than two complications (Wald=4.915, P=0.027, OR=0.155) and smoking history (Wald=6.853, P<0.05, OR=10.917) was independent risk factors of postoperative in-hospital death. Conclusions The risks of perioperative pulmonary infection and acute myocardial infarction were relatively higher in postoperative geriatric hip fractures. Attention should be paid on elderly patients with more comorbidity or smoking history.

相似文献/References:

[1]吴斗,郝海虎,朱剑,等.老年髋部骨折术后谵妄的危险因素分析[J].中华老年骨科与康复电子杂志,2015,(01):34.
[2]姬晨妮,陈伟,朱燕宾,等.京津唐地区1 583例老年股骨转子间骨折流行病学特征分析[J].中华老年骨科与康复电子杂志,2015,(01):45.
[3]裴宝瑞,吴啸波,李力更,等.应用低分子肝素钙预防老年髋部骨折术前静脉血栓栓塞症的剂量研究[J].中华老年骨科与康复电子杂志,2016,(02):76.[doi:10.3877/cma.j.issn.2096-0263.2016.02.003]
　Pei Baorui,Wu Xiaobo,Li Ligeng,et al.The efficacy of low molecular weight heparin calcium of preventive versus therapeutic dose in prevention of venous thromboembolism in elderly patients before hip fracture surgery[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2016,(01):76.[doi:10.3877/cma.j.issn.2096-0263.2016.02.003]
[4]钟俊青,王连成.快速外科通道理念对老年股骨转子间骨折围手术期康复指导的前瞻性研究[J].中华老年骨科与康复电子杂志,2016,(02):87.[doi:10.3877/cma.j.issn.2096-0263.2016.02.005]
　Zhong Junqing,Wang Liancheng..Prospective study of the effect of fast track surery on peri-operative rehabilitation of elderly intertrochanteric fracture[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2016,(01):87.[doi:10.3877/cma.j.issn.2096-0263.2016.02.005]
[5]吴啸波,裴宝瑞.老年髋部骨折围手术期相关问题的研究进展[J].中华老年骨科与康复电子杂志,2016,(02):114.[doi:10.3877/cma.j.issn.2096-0263.2016.02.010]
　Wu Xiaobo,Pei Baorui..Perioperative related problems of surgery in elderly patients with hip fractures[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2016,(01):114.[doi:10.3877/cma.j.issn.2096-0263.2016.02.010]
[6]张静,李志锐,唐佩福.老年粗隆间骨折的手术治疗进展[J].中华老年骨科与康复电子杂志,2016,(04):250.[doi:10.3877/cma.j.issn.2096-0263.2016.04.011]
　Li Zhirui,Zhang Jing,Tang Peifu.Progress of surgical treatment for femoral intertrochanteric fracture in the elderly patients[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2016,(01):250.[doi:10.3877/cma.j.issn.2096-0263.2016.04.011]
[7]侯建伟,谢仁国,李玉前,等.加长型 PFNA-Ⅱ和DHS治疗老年骨质疏松性股骨转子下骨折的疗效分析[J].中华老年骨科与康复电子杂志,2017,(01):22.[doi:10.3877/cma.j.issn.2096-0263.2017.01.005]
　Hou Jianwei,Xie Renguo,Li Yuqian,et al.Clinical effective analysis of lengthened PFNA- II fixation and dynamic hip screw for senile osteoporotic subtrochanteric fractures[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2017,(01):22.[doi:10.3877/cma.j.issn.2096-0263.2017.01.005]
[8]于沂阳,李石伦,陈伟,等.中国北方和南方地区 2010—2011年 60岁以上人群股骨转子间骨折流行病学对比[J].中华老年骨科与康复电子杂志,2017,(01):55.[doi:10.3877/cma.j.issn.2096-0263.2017.01.011]
　Yu Yiyang,Li Shilun,Chen Wei,et al.Epidemiological comparison of geriatric intertrochanteric fractures between north and south areas of China from 2010 to 2011[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2017,(01):55.[doi:10.3877/cma.j.issn.2096-0263.2017.01.011]
[9]徐进,李平,马信龙.老年髋部骨折手术快通道化变革中的麻醉管理[J].中华老年骨科与康复电子杂志,2017,(01):59.[doi:10.3877/cma.j.issn.2096-0263.2017.01.012]
　Xu Jin,Li Ping,Ma Xinlong.Anesthetic management of immediate reparative surgery in elderly patients with hip fractures[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2017,(01):59.[doi:10.3877/cma.j.issn.2096-0263.2017.01.012]
[10]陈佳,李西成.髋部骨折：争议与挑战[J].中华老年骨科与康复电子杂志,2017,(04):193.[doi:10.3877/cma.j.issn.2096-0263.2017.04.001]
　Chen Jia,Li Xicheng.Hip fracture: Controversy and challenge[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2017,(01):193.[doi:10.3877/cma.j.issn.2096-0263.2017.04.001]

备注/Memo

备注/Memo:
基金项目：中国医学科学院中央级公益性科研院所基本科研业务费项目（2015PT320014）
更新日期/Last Update: 2017-04-01