文章摘要
老年患者髋部骨折手术围术期输血与术后死亡的相关性
Association between perioperative blood transfusion and mortality after hip fractures in elderly patients
  
DOI：10.12089/jca.2026.07.007
中文关键词: 髋部骨折  老年  围术期输血  死亡率  脊髓麻醉
英文关键词: Hip fracture  Aged  Perioperative blood transfusion  Mortality  Spinal anesthesia
基金项目:
作者单位E-mail
陈武斌 200433,上海市,海军军医大学附属长海医院麻醉科  
汪后生 200433,上海市,海军军医大学附属长海医院麻醉科  
高天祥 200433,上海市,海军军医大学附属长海医院麻醉科  
饶苗苗 200433,上海市,海军军医大学附属长海医院麻醉科  
卞金俊 200433,上海市,海军军医大学附属长海医院麻醉科  
卢文斌 200433,上海市,海军军医大学附属长海医院麻醉科 chwenbinlu@sina.com 
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中文摘要:
      
目的：探讨围术期输血（PBT）与老年患者髋部骨折术后3个月及6个月全因死亡的相关性。
方法：回顾性收集脊髓麻醉下行髋部骨折手术老年患者的临床资料，包括年龄、性别、BMI、ASA分级、贫血状况、合并症、从受伤至入院的时间以及PBT情况。主要结局为术后6个月的全因死亡，次要结局为术后3个月的全因死亡。根据是否接受PBT，将患者分为PBT组与非PBT组。采用多因素Cox比例风险回归模型，计算其风险比（HR）及95%可信区间（CI），并逐步校正年龄、性别、BMI、ASA分级、糖尿病、肺部疾病、肾脏疾病及贫血程度等混杂因素，按年龄、性别、ASA分级、贫血程度分层进行亚组分析，评估PBT与术后死亡的关系。
结果：共纳入1 436例患者，其中PBT组603例（42.0%）。多因素Cox回归分析显示，PBT与老年患者髋部骨折术后3个月死亡（HR=2.98，95%CI 1.35～6.60，P=0.007）和6个月死亡（HR=1.89，95%CI 1.10～3.25，P=0.022）独立相关。亚组分析结果显示，PBT与死亡的关系在年龄、性别、ASA分级、贫血程度各亚组中保持一致。
结论：PBT与老年患者髋部骨折术后死亡风险增加相关，该关联在年龄、性别及贫血程度等亚组中总体一致。
英文摘要:
      
Objective: To investigate the association between perioperative blood transfusion (PBT) and all-cause mortality at 3 and 6 months after surgery in elderly patients with hip fractures.
Methods: Clinical data of elderly patients undergoing hip fracture surgery under spinal anesthesia were retrospectively collected, including age, sex, BMI, ASA physical status, anemia status, comorbidities, time from injury to admission, and PBT status. The primary study outcome was all-cause mortality at 6 months postoperatively, and the secondary study outcome was all-cause mortality at 3 months postoperatively. Patients were divided into the PBT group and the non-PBT group based on whether they received PBT. A multivariate Cox proportional hazards regression model adjusted for confounding factors such as age, sex, BMI, ASA physical status, diabetes, pulmonary disease, renal disease, and degree of anemia was used to evaluate the association between PBT and mortality after surgery, with hazard ratio (HR) and 95% confidence interval (CI) estimated from the model. Subgroup analysis was also performed to evaluate the relationship between PBT and postoperative mortality in different subgroups stratified by age, sex, ASA physical status, and degree of anemia.
Results: A total of 1 436 patients were included,of whom 603 (42.0%) received PBT. Multivariate Cox regression analysis showed that PBT was an independent risk factor for 3-month mortality after surgery (HR = 2.98, 95% CI 1.35-6.60, P = 0.007) and 6-month mortality after surgery (HR = 1.89, 95% CI 1.10-3.25, P = 0.022) in elderly patients with hip fractures. Subgroup analysis indicated that the relationship between PBT and mortality was generally consistent across all subgroups, including age, sex, ASA physical status, and degree of anemia.
Conclusion: PBT was associated with an increased risk of mortality after surgery in elderly patients with hip fractures. This association was generally consistent across subgroups of patients by age, sex, and degree of anemia, but was more pronounced in patients with ASA physical status ≥ Ⅲ.
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