摘要
目的分析影响老年髋部骨折手术患者1年死亡率的相关因素。方法回顾性分析2017年1月至2018年4月在温州医科大学附属第二医院行髋部骨折手术治疗的老年患者病历资料,符合研究纳入标准共489例,收集年龄、性别、查尔森合并症指数、骨折类型、入院Braden评分、美国麻醉医师协会(ASA)分级、住院天数、麻醉方式、全血细胞分析指标等信息,通过单因素及多因素Cox回归模型分析与患者1年死亡率相关的因素。结果489例患者根据排除标准剔除39例,最终纳入分析共450例。该队列中患者术后1个月死亡率为3.33%(15/450)、6个月死亡率为7.78%(35/450)、1年死亡率为10.89%(49/450)。单因素Cox分析显示与术后1年死亡率有统计学相关的指标分别为年龄、性别、ASA分级、骨折类型、查尔森合并症指数、入院Braden评分、镇痛方式、术前血红蛋白值、术前白蛋白值、术后高活动性谵妄。多因素Cox回归分析显示年龄>80岁(HR=2.32,95%CI:1.11~4.85,P=0.025)、查尔森合并症指数≥3分(HR=3.24,95%CI:1.75~6.03,P<0.001)、入院Braden评分≤16分(HR=1.93,95%CI:1.03~3.57,P=0.040)、术后高活动性谵妄(HR=2.49,95%CI:1.16~5.35,P=0.019)是髋部骨折患者1年内死亡的危险因素。结论本队列研究的老年髋部骨折手术患者1年死亡率为10.89%;年龄>80岁、查尔森合并症指数≥3分、入院Braden评分≤16分、术后高活动性谵妄是髋部骨折患者1年内死亡的危险因素。
Objective To analyze the related factors that affect the one‑year mortality in elderly patients following hip fracture surgery.Methods The clinical data of the elderly patients who needed a surgery for hip fracture in the Second Affiliated Hospital of Wenzhou Medical University from January 2017 to April 2018 were retrospectively analyzed.According to the inclusion criteria of the study,489 cases were included.Then the information of patients including age,sex,Charlson comorbidity index,type of fracture,Braden score at admission,American Society of Anesthesiologists(ASA)score,length of hospital stay,type of anesthesia,whole blood cells analysis were collected.Univariate and multivariate Cox regression analyses were conducted to investigate the factors related to one‑year mortality of patients.Results After excluding 39 patients,450 patients were finally included.Patients in this cohort study had a mortality rate of 3.33%(15/450)at 1 month,7.78%(35/450)at half a year,and 10.89%(49/450)at 1 year after surgery.Univariate analysis showed that age,sex,ASA score,type of fracture,Charlson comorbidity index,Braden score at admission,type of analgesia,preoperative hemoglobin concentration,preoperative albumin concentration,postoperative delirium of high activity correlated with one‑year mortality after surgery.Further,multivariate Cox regression analysis revealed that age>80 years old(HR=2.32,95%CI:1.11-4.85,P=0.025),Charlson comorbidity index≥3(HR=3.24,95%CI:1.75-6.03,P<0.001),Braden score at admission≤16(HR=1.93,95%CI:1.03-3.57,P=0.040)and postoperative delirium of high activity(HR=2.49,95%CI:1.16-5.35,P=0.019)were risk factors for one‑year mortality.Conclusions The current study indicates that one‑year mortality rate of elderly patients following hip fracture surgery is 10.89%.Meanwhile,age>80 years,Charlson comorbidity index≥3,Braden score at admission≤16,postoperative delirium of high activity are risk factors for one‑year mortality.
作者
周盈丰
濮玲菲
林启程
袁开明
李军
Zhou Yingfeng;Pu Lingfei;Lin Qicheng;Yuan Kaiming;Li Jun(Department of Anesthesiology and Perioperative Medicine,the Second Affiliated Hospital&Yuying Children′s Hospital,Wenzhou Medical University,Wenzhou 325027,China;The People′s Hospital of Shaoxing,Shaoxing 312000,China Zhou Yingfeng and Pu Lingfei contributed equally to this article)
出处
《中华医学杂志》
CAS
CSCD
北大核心
2021年第17期1269-1274,共6页
National Medical Journal of China
关键词
髋骨折
老年人
手术
死亡率
Hip fractures
Aged
Surgery
Mortality
