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| 老年患者髋部骨折术后肺部并发症的危险因素 |
| Risk factors analysis of postoperative pulmonary complications in elderly patients undergoing hip fracture surgery |
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| DOI：10.12089/jca.2019.07.004 |
| 中文关键词: 老年患者 髋部骨折 术后并发症 危险因素 |
| 英文关键词: Elderly patients Hip fracture Postoperative complication Risk factors |
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| 摘要点击次数: 3581 |
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| 中文摘要: |
目的 采用巢式病例-对照研究分析老年髋部骨折患者术后肺部并发症的危险因素。
方法 回顾性分析我院2005年1月至2014年12月诊治的老年髋部骨折患者的临床资料，对其中术后新发生肺部并发症的56例患者（研究组），采用巢式病例-对照研究的方法，按照1∶6匹配同期同类未发生肺部并发症的336例患者（对照组），探讨性别、年龄、术前并存疾病（心脏疾病、高血压、肺部疾病、糖尿病、脑血管疾病和慢性肾脏疾病）、术前卧床时间、手术方式、麻醉方法、失血量和手术时间对术后肺部并发症的影响。
结果 572例老年髋部骨折患者中，56例术后新发肺部并发症，单因素分析显示，研究组年龄明显大于对照组（P<0.05），术前合并肺部疾病、髓外固定术、全身麻醉比例明显高于对照组（P<0.05），术前卧床时间明显长于对照组（P<0.05）。多因素Logistic回归分析显示，高龄（OR=1.12，95%CI 1.07～1.18，P<0.001）、术前合并肺部疾病（OR=3.30，95%CI 1.34～8.15，P=0.010）、术前卧床时间延长（OR=1.29，95%CI 1.15～1.44，P<0.001）、髓外固定术（OR=5.69，95%CI 2.10～15.39，P=0.001）和全身麻醉（OR=2.15，95%CI 1.05～4.40，P=0.036）是老年髋部骨折患者术后新发肺部并发症的独立危险因素。
结论 高龄、术前合并肺部疾病、术前卧床时间延长、髓外固定术和全身麻醉可以作为老年髋部骨折患者术后新发肺部并发症的独立危险因素，针对危险因素进行干预或可降低术后肺部并发症的发生。 |
| 英文摘要: |
Objective To investigate the risk factors of postoperative pulmonary complications after hip fracture surgery in elderly patients using a nested case-control design.
Methods A retrospective analysis was conducted according to the medical records of elderly patients with hip fractures admitted to our hospital from January, 2005 to December, 2014, among which 56 cases were diagnosed with new pulmonary complications occurred postoperatively. A total of 336 cases with similar surgical types, date of operation and anesthesia technique were explored as control group according to the principle of the nested case-control design with the ratio of 1∶6. The possible risk factors for postoperative pulmonary complications were evaluated including age, sex, preoperative comorbidities, preoperative bed time, surgical types, anesthetic methods, blood loss and operation time.
Results A total of 572 patients, postoperative pulmonary complications occurred in 56. Univariate analysis showed that the age of the study group was significantly older than that of the control group (P < 0.05). The proportion of preoperative pulmonary comorbidities, extramedullary internal fixation and general anesthesia was significantly higher than that of the control group (P < 0.05). The bed time before surgery was significantly longer than that of the control group (P< 0.05). Multiple logistic regression analysis showed that age (OR = 1.12, 95% CI 1.07 - 1.18, P < 0.001), preoperative pulmonary comorbidities (OR = 3.30, 95% CI 1.34 - 8.15, P = 0.010), preoperative bed time (OR = 1.29, 95% CI 1.15 -1.44, P < 0.001), extramedullary internal fixation (OR = 5.69, 95% CI 2.10 - 15.39, P = 0.001) and anesthetic methods (OR = 2.15, 95% CI 1.05 - 4.40, P = 0.036) were independent risk factors for postoperative pulmonary complications after hip fracture surgery in elderly patients.
Conclusion Older age, preoperative pulmonary comorbidities, prolonged bed time before surgery, extramedullary internal fixation and general anesthesia can be used as independent risk factors for new postoperative pulmonary complications in elderly patients undergoing hip fracture surgery. Interventions for risk factors may reduce the risk of postoperative pulmonary complications. |
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