摘要
目的探讨行关节置换的老年股骨颈骨折患者围术期发生心功能衰竭的相关危险因素，从而对其围术期心功能衰竭的预防提供相关临床参考。方法采用回顾性病例对照研究分析2012年5月-2016年8月温州市中西医结合医院行全髋或半髋置换的155例老年股骨颈骨折患者，其中男62例，女93例；年龄（75．6±7．4）岁。按围术期是否发生心功能衰竭，将患者分为心功能衰竭组（26例）和未发生心功能衰竭组（129例）。心功能衰竭组男10例，女16例；年龄（78．3±8．2）岁。未发生心功能衰竭组男52例，女77例；年龄（74．5±6．7）岁。收集患者年龄、性别、高血压病史、术前心功能、美国麻醉学会（ASA）身体状况分级、受伤至手术时间、术前肾功能、围术期液体出入量差值、手术方式、手术时间、术后疼痛评分、围术期失血量、便秘等资料。先对以上资料行单因素分析，再对其结果有统计学意义的因素进行多因素Logistic回归分析，以明确其围术期心功能衰竭的独立危险因素。结果单因素分析显示，两组在年龄、心脏病病史、术前肾功能、围术期液体卅入量差值方面差异有统计学意义（P均〈0．05）。多因素分析显示，其围术期年龄（OR=5．351，95％CI1．459～19．623，P〈0．01）、心脏病病史（OR=5．717，95％CI2．399～13．624，P〈0．01）、术前肾功能（OR=2．670，95％CI1．125～6．336，P〈0．05）、围术期液体出入量差值（OR=2．980，95％CI1．287～6．899，P〈0．01）与心功能衰竭显著相关。结论老年股骨颈骨折患者关节置换围术期发生心功能衰竭的危险因素为年龄、心脏病病史、术前肾功能、围术期液体出入量差值。应重点关注以上危险因素并采取相应的围术期预防处理措施，从而降低围术期心功能衰竭的发生。
Objective To investigate the risk factors of perioperative heart failure in the elderly patients with femoral neck fracture treated with hip joint replacement so as to provide relevant clinical reference. Methods A retrospective case control study was conducted to analyze the clinical data of 155 elderly patients with femoral neck fractures who underwent total hip or hemiarthroplasty in Wenzhou Traditional Chinese and Western Medicine Hospital from May 2012 to August 2016. There were 62 males and 93 females, aged （75.6 ± 7.4） years. The patients were divided into heart failure group （26 patients） and non heart failure group （129 patients）. Heart failure group included 10 males and 16 females, aged （78.3 ± 8.2）years. There were 52 males and 77 females in the non heart failure group, aged （74.5 ± 6.7） years. Information including age, gender, history of hypertension, history of heart diseases, American Society of Anesthesiologists （ASA） physical status classification, duration from injury to surgery, preoperative renal function, perioperative fluid balance, operation method, operation time, postoperative pain score, perioperative blood loss, and constipation were collected. Univariate analysis was firstly performed on the above data, and multivariate logistic regression analysis was conducted on the significant factors generated by the univariate analysis so as to identify independent risk factors for perioperative heart failure. Results According to the univariate analysis, age, history of heart diseases, preoperative renal function, and perioperative fluid balance were statistically different between the two groups （P 〈 0.05 ）. Multivariate analysis results showed that the independent risk factors of perioperative heart failure included age （ OR = 5. 351, 95% CI 1. 459-19. 623, P 〈 0.01 ） , history of heart diseases （ OR = 5.717, 95 % CI 2. 399-13. 624, P 〈 0.01 ）, preoperative renal function （OR = 2.670, 95% CI 1. 125-6. 336, P 〈 0.05 ）, perioperative fluid bala
作者
季日旭
陈作喜
吴银生
刘焕兴
李崇清
Ji Rixu;Chen Zuoxi;Wu Yinsheng;Liu Huanxing;Li Chongqing(Department of Orthopedics,Wenzhou Traditional Chinese and Western Medicine Hospital,Wenzhou 325200,China)
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2018年第11期1030-1034,共5页
Chinese Journal of Trauma
关键词
股骨颈骨折
心力衰竭
危险因素
Femoral neck fractures
Heart failure
Risk factors
