摘要
目的筛选行下肢骨折手术的老年患者术后住院期间心脑血管事件和1年内死亡的危险因素。方法选择2010年1月至2014年12月择期行下肢骨折手术的老年患者430例，年龄≥65岁，记录患者年龄、性别、ASA分级、术前合并疾病（糖尿病、心脑血管疾病及偏瘫）、术前有无贫血、手术部位（髋部及股骨、膝关节及其以下部位）、麻醉方式（全身麻醉、椎管内麻醉）、手术时间、术中有无高血压及低血压、术中出血量、术后住院期间有无Hb≤90 g/L、术后引流量、术后有无肺炎及转入ICU，根据患者术后住院期间是否发生心脑血管事件，分为心脑血管事件组和非心脑血管事件组；根据患者术后1年生存状况，分为生存组和死亡组。分别将组间差异有统计学意义的因素进行多因素logistic回归分析，筛选行下肢骨折手术的老年患者术后住院期间心脑血管事件和1年内死亡的危险因素。结果最终372例患者完成本研究。其中35例患者术后住院期间发生心脑血管事件，发生率为9.4%，logistic回归分析结果显示，术前合并心脑血管疾病及ASA分级≥Ⅲ级是术后住院期间发生心脑血管事件的危险因素；33例患者术后1年内死亡，死亡率为8.9%，logistic回归分析结果显示，年龄≥75岁、术前合并偏瘫和术后住院期间发生心脑血管事件为术后1年内死亡的危险因素。结论老年患者下肢骨折术后住院期间心脑血管事件的独立危险因素为术前合并心脑血管疾病和ASA分级≥Ⅲ级；术后1年内死亡的独立危险因素为年龄≥75岁、术前合并偏瘫和术后住院期间心脑血管事件。
ObjectiveTo identify the risk factors for in-hospital cardio-cerebrovascular events and 1-year mortality following lower extremity fracture surgery in elderly patients.MethodsFour hundred and thirty patients, aged ≥ 65 yr, undergoing elective lower extremity fracture surgery from January 2010 to December 2014, were selected.Age, gender, American Society of Anesthesiologists （ASA） physical status, preoperative comorbidities （diabetes mellitus, cardio-cerebrovascular events and hemiplegia）, preoperative anemia, surgical site （hip and femur, knee joint and the site below the knee）, anesthesia method （general anesthesia, neuraxial anesthesia）, surgery time, intraoperative hypertension and hypotension, intraoperative blood loss, postoperative Hb≤90 g/L in hospital and volume of postoperative drainage, postoperative pneumonia and admission to the intensive care unit after operation were recorded.The patients were divided into either cardio-cerebrovascular event group or non-cardio-cerebrovascular event group according to whether the patients developed cardio-cerebrovascular events after surgery in hospital.The patients were divided into either survival group or dead group according to the living status 1 yr after surgery.The risk factors of which P values were less than 0.05 would enter the multi-factor logistic regression analysis to stratify the risk factors for in-hospital cardio-cerebrovascular events and 1-year mortality following lower extremity fracture surgery.ResultsThree hundred and seventy-two patients completed the study.Among the 372 patients, 35 patients developed postoperative cardio-cerebrovascular events in hospital, and the incidence was 9.4%, logistic regression analysis showed that the preoperative cardio-cerebrovascular diseases and ASA physical status ≥ Ⅲ were risk factors for in-hospital postoperative cardio-cerebrovascular events.Thirty-three patients died within 1 yr after surgery, the mortality rate was 8.9%, and logistic regression analysis showed that age≥75 yr, preoperative hemiplegia and development of cardio-cerebrovascular events after surgery in hospital were postoperative 1-year mortality-related risk factors.ConclusionPreoperative cardio-cerebrovascular diseases and ASA physical status ≥ Ⅲ are the independent risk factors for in-hospital cardio-cerebrovascular events following lower extremity fracture surgery in elderly patients; age≥75 yr, preoperative hemiplegia and in-hospital postoperative cardio-cerebrovascular events are the independent risk factors for 1-year mortality after surgery.
作者
张见岗
倪坤
侯百灵
郁万友
杨磊
顾小萍
马正良
Zhang Jiangang;Ni Kun;Hou Bailing;Yu Wanyou;Yang Lei;Gu Xiaoping;Ma Zhengliang(Drum Tower Clinical College, Nanjing Medical University, Nanjing 210008, China;Department of Anesthesiology, Affiliated Jiangning Hospital, Nanjing Medical University, Nanjing 211100, China)
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2018年第3期266-270,共5页
Chinese Journal of Anesthesiology
基金
江苏省医学重点学科[苏卫科教（2017）1号]
江苏省医学重点人才[苏卫科教（2017）1号]
中央高校基本科研业务费专项资金资助（021414380014）
关键词
老年人
骨折
手术后并发症
危险因素
Aged
Fractures
bone
Postoperative complications
Risk factors
