摘要
目的评估骨质疏松性髋部骨折患者心脏并发症的发生率与风险因素。方法采用回顾性病例系列研究，从天津市城镇职工基本医疗保险数据30％随机抽样数据库（2009—2014年）筛选2010—2013年有≥1次髋部骨折诊断、年龄I〉50岁、首次骨折诊断前后12个月持续参保的2353例髋部骨折患者纳入研究。分析患者基线特征；评估患者骨折后3，6，9和12个月心脏并发症发生率，并对各类心脏并发症骨折前后12个月内的发生率进行比较；采用多因素Cox比例风险模型分析心脏并发症发生的风险因素。结果2353例髋部骨折患者的年龄为（71．4±10．3）岁，其中58．4％为女性患者。髋部骨折后，患者心律失常（23．2％：9．7％，OR=2．39，95％CI2．11～2．72，P〈0．01）、心绞痛（16．0％：7．9％，OR=2．03，95％CI1．75～2．35，P〈0．01）、心力衰竭（5．9％：2．7％，OR=2．19，95％C11．68～2．85，P〈0．01）及心肌梗死（3．2％：2．0％，OR=1．63，95％CI1．19～2．23，P〈0．01）的发生率均显著高于骨折前，且多发生在骨折后3个月内。患者年龄越大（OR=1．01，95％CI1．00～1．02，P〈0．01）和基线期合并有高血压（OR=1．40，95％CI1．14～1．73，P〈0．01）、冠心病（OR=1．25，95％CI1．01～1．53，P〈0．05）、高血脂（OR=1．20，95％CI1．02—1．42，P〈0．05）、慢性肺部疾病（OR=1．18，95％CI1．01～1．38，P〈0．05）、充血性心力衰竭（OR=1．70，95％CI1．16～2．50，P〈0．01）、心律失常（OR=1．88，95％C11．54—2．29，P〈0．01）或肾脏疾病（OR=1．35，95％C11．07—1．69，P〈0．05），心脏并发症的发生风险越高。结论骨质疏松性髋部骨折患者心脏并发症发生率较高，高龄与基线期合并症是心脏并发症的风险因素。
Objective To estimate the incidence and risk factors of cardiac complications in patients with osteoporotic hip fractures. Methods A retrospective case series study was conducted on the clinical data obtained from 30% of the randomized sample population of Tianjin Urban Employee Basic Medical Insurance database （2009-2014）. Patients who had ≥ 1 diagnoses of hip fracture between 2010 and 2013, aged≥50 years, and were continuously enrolled from 12 months before （baseline period） to 12 months after （follow-up period） the first osteoporotic hip fracture diagnosis were included in this study. The incidences of cardiac complications were estimated at 3, 6, 9 and 12 months after the fractures, and incidences of cardiac complications which occurred 12 months before and after the fracture were compared. Multiple factors cox proportional hazards regression was used to identify the risk factors of cardiac complications after osteoporotic hip fractures. Results A total of 2 353 osteoporotic hip fracture patients were included [ age ： （ 71.4 ＋ 10.3 ） years ; female ： 58.4% ]. After hip fracture, the accumulated 12-month incidence of arrhythmia （23.2% vs. 9. 7%, OR = 2.39, 95% CI 2.11 2.72, P 〈 0.01）, angina （16.0% vs. 7.9%, OR=2.03, 95%CI 1.75 2.35, P〈0.01）, heart failure （5.9% vs.2.7% , OR=2.19, 95%CI 1.68 2.85, P〈0.01） and myocardial infarction （3.2% vs. 2.0% , OR= 1.63, 95% CI 1. 19 2.23, P 〈 0.01 ） were significantly higher than those before fracture, and these complications mostly occurred within 3 months after osteoporotic hip fracture. Patients aged older （ OR = 1.01, 95% CI 1.00 1.02, P 〈0.01 ） with the history of hypertension （ OR = 1.40, 95% CI 1.14 1.73, P 〈 0.01 ）, coronary heart disease （ OR = 1.25, 95 % CI 1.01 1.53, P 〈 0.05 ） , hyperlipidemia （ OR = 1.20, 95% CI 1.02 1.42, P 〈 0.05 ）, chronic pulmonary diseases （ OR = 1.18, 95% CI 1.01 1.38, P 〈 0.05 ）, congestive heart failure （ OR = 1.70, 95% CI 1.16 2.50, P 〈 0.01 ） , arrh
作者
刘瑞奇
吴晶
Liu Ruiqi;Wu Jing.(School of Pharmaceutical Science and Technology, Tianjin University, Tianjin 300072, Chin)
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2018年第4期357-361,共5页
Chinese Journal of Trauma
关键词
骨质疏松性骨折
髋骨折
手术后并发症
心脏病
风险因素
Osteoporositic fractures
Hip fractures
Postoperative complications
Heart diseases
Risk factors
