[1]沈浩,王伟,何继业,等.老年髋部骨折术前合并急性脑梗塞的危险因素分析[J].中华老年骨科与康复电子杂志,2017,(05):275-280.[doi:10.3877/cma.j.issn.2096-0263.2017.05.005]
 Shen Hao,Wang Wei,He Jiye,et al.Risk factors analysis for preoperative acute cerebral infarction in elderly hip fracture patients[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2017,(05):275-280.[doi:10.3877/cma.j.issn.2096-0263.2017.05.005]
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老年髋部骨折术前合并急性脑梗塞的危险因素分析()
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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05期
页码:
275-280
栏目:
髋部骨折
出版日期:
2017-09-18

文章信息/Info

Title:
Risk factors analysis for preoperative acute cerebral infarction in elderly hip fracture patients
作者:
沈浩王伟何继业张翔陈晓东
200092 上海交通大学医学院附属新华医院成人骨科
Author(s):
Shen Hao Wang Wei He Jiye Zhang Xiang Chen Xiaodong
Department of Orthopaedic Surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
关键词:
髋骨折 老年人 脑梗塞
Keywords:
Hip fractures Aged Cerebral infarction
DOI:
10.3877/cma.j.issn.2096-0263.2017.05.005
文献标志码:
A
摘要:
目的 探讨老年髋部骨折术前合并急性脑梗塞的危险因素。方法 收集2013年1月至2016年12月上海交通大学附属新华医院收治的老年髋部骨折病例,术前常规行头颅核磁共振检查,记录并分析脑梗塞和无脑梗塞两组患者的年龄、性别、血脂水平、骨折部位、既往病史(包括高血压、糖尿病、房颤)、吸烟史、饮酒史和使用抗凝药物史,采用多因素Logistic回归分析老年髋部骨折术前合并脑梗塞的危险因素。结果 共纳入349例患者,其中45例(13%)出现急性脑梗塞。单因素分析显示组间高血压病史(c2=15.382,P<0.01)、高血脂(c2=5.382,P<0.05)、糖尿病史(c2=7.108,P<0.01)、房颤病史(c2=12.678,P<0.01)及抗凝药物使用史(c2=43.107,P<0.01)的差异有统计学意义。多因素Logistic回归分析显示老年髋部骨折术前合并脑梗塞的危险因素有高血压病史,OR值为1.144(95% CI:0.087~0.182);糖尿病史,OR值为1.724(95% CI:0.176~0.914);高血脂,OR值为2.843(95% CI:0.226~0.863);房颤病史,OR值为2.126(95% CI:1.281~3.528)。结论 高血压病史、糖尿病史、高血脂和房颤病史是老年髋部骨折术前合并脑梗塞的独立危险因素,该类患者应常规行头颅核磁共振检查以明确有无合并急性脑梗塞。
Abstract:
Objective To investigate relative risk factors of preoperative acute cerebral infarction in elderly patients with hip fracture. Methods Patients with hip fractures diagnosed between January 2013 and December 2016 in Hospital Affiliated to Shanghai Jiaotong University School of Medicine were enrolled in this study. All patients had magnetic resonance imaging examination before operation. Age, gender, serum lipid level, BMI, medical history (hypertension, diabetes, atrial fibrillation), smoking, drunk and anticoagulant drug use history of acute cerebral infarction group and non-acute cerebral infarction group were recorded preoperatively and analysis were done using Multi-factor Logistic regression analysis. Results 171 cases were included, 15 patients (9%) had acute cerebral infarction. There were significant differences on hypertension (c2=15.382, P=0.020), hyperlidemia (c2=5.382, P=0.002), diabetes (c2=7.108, P<0.01), atrial fibrillation (c2=12.678, P<0.01), anticoagulant drug use history (c2=43.107, P=0.006) by single factor analysis. While multi-factor Logistic regression analysis showed that OR of hypertension was 1.144(95% CI: 0.087, 0.182); OR of diabetes was 1.724 (95% CI: 0.176, 0.914); OR of hyperlidemia was 2.843 (95% CI: 0.226, 0.863); OR of atrial fibrillation was 2.126 (95% CI: 1.281, 3.528). Conclusion Hypertension, hyperlidemia, diabetes and atrial fibrillation are independent risk factors of acute cerebral infarction in elderly patients with hip fractures. Such patients should have routine magnetic resonance imaging examination before operation.

参考文献/References:

1 Adams PF, Kirzinger WK, Martinez ME. Summary health statistics for the u.s. Population: National health interview survey, 2011 [J]. Vital Health Stat 10, 2012 (255): 1-110.
2 Aschkenasy MT, Rothenhaus TC. Trauma and falls in the elderly [J]. Emerg Med Clin North Am, 2006, 24(2): 413.
3 Fisher M. Stroke and TIA: epidemiology, risk factors, and the need for early intervention [J]. Am J Manag Care, 2008, 14(6 Suppl 2): S204-S211.
4 Perry HM, Davis BR, Price TR, et al. Effect of treating isolated systolic hypertension on the risk of developing various types and subtypes of stroke: the Systolic Hypertension in the Elderly Program (SHEP) [J]. JAMA, 2000, 284(4): 465-471.
5 Davidson MH. Overview of prevention and treatment of atherosclerosis with lipid-altering therapy for pharmacy directors [J]. Am J Manag Care, 2007, 13(Suppl 10): S260-S269.
6 Chambless LE, Folsom AR, Davis V, et al. Risk factors for progression of common carotid atherosclerosis: the Atherosclerosis Risk in Communities Study, 1987-1998 [J]. Am J Epidemiol, 2002, 155(1): 38-47.
7 Creager MA, Luscher TF, Consentino F, et al. Diabetes and vascular disease: pathophysiology, clinical consequences, and medical therapy: part 1[J]. Circulation, 2003; 108: 1527-1532.
8 Investigators AF. Risk factors for stroke and efficacy of antithrombotic therapy in atrial fibrillation. Analysis of pooled data from five randomized controlled trials [J]. Arch Intern Med, 1994, 154(13): 1449-1457.
9 Singer DE, Albers GW, Dalen JE, et al. Antithrombotic therapy in atrial fibrillation: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy [J]. Chest, 2004, 126(3 Suppl): 429S-456S.
10 Feigin VL, Lawes CM, Bennett DA, et al. Stroke epidemiology: a review of population-based studies of incidence, prevalence, and case-fatality in the late 20th century [J]. Lancet Neurol, 2003, 2(1): 43-53.
11 Campbell GB, Matthews JT. An integrative review of factors associated with falls during post-stroke rehabilitation [J]. J Nurs Scholarsh, 2010, 42(4): 395-404.
12 Kelley RE. Stroke in the postoperative period [J]. Med Clin North Am, 2001, 85(5): 1263-1276.
13 Song SH, Kim JH, Lee JH, et al. Elevated blood viscosity is associated with cerebral small vessel disease in patients with acute ischemic stroke [J]. BMC Neurol, 2017, 17(1): 20.
14 Pickard AS, Becker RC, Schumock GT, et al. Clopidogrel-associated bleeding and related complications in patients undergoing coronary artery bypass grafting [J]. Pharmacotherapy, 2008, 28(3): 376-392.
15 Johansen A, White J, Turk A. Clopidogrel therapy--implications for hip fracture surgery [J]. Injury, 2008, 39(10): 1188-1190.
16 Manaqibwala MI, Butler KA, Sagebien CA. Complications of hip fracture surgery on patients receiving clopidogrel therapy [J]. Arch Orthop Trauma Surg, 2014, 134(6): 747-753.
17 Harty JA, Mckenna P, Moloney D, et al. Anti-platelet agents and surgical delay in elderly patients with hip fractures [J]. J Orthop Surg (Hong Kong), 2007, 15(3): 270-272.
18 Sköldenberg OG, Salemyr MO, Bodén HS, et al. A new uncemented hydroxyapatite-coated femoral component for the treatment of femoral neck fractures: two-year radiostereometric and bone densitometric evaluation in 50 hips [J]. J Bone Joint Surg Br, 2011, 93(5): 665-677.
19 李玉龙, 翁习生, 李涛, 等. 双极人工股骨头置换术后脱位的影响因素 [J]. 中华医学杂志, 2016, 96(15): 1212-1214.
20 Guerra MT, Pasqualin S, Souza MP. Functional recovery of elderly patients with surgically-treated intertrochanteric fractures: preliminary results of a randomised trial comparing the dynamic hip screw and proximal femoral nail techniques [J]. Injury, 2014, 45(Suppl 5): S26-S31.
21 Chua IT, Rajamoney GN, Kwek EB. Cephalomedullary nail versus sliding hip screw for unstable intertrochanteric fractures in elderly patients [J]. J Orthop Surg, 2013, 21(3): 308-312.

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备注/Memo

备注/Memo:
基金项目:国家自然科学基金(81572172)
更新日期/Last Update: 2017-09-15