摘要
目的探讨老年髋部骨折患者入院时低氧血症情况及相关危险因素。方法回顾性分析2017年5月至2019年3月于北京积水潭医院急诊科就诊的1599例老年髋部骨折患者的临床资料。根据氧合指数将患者分为低氧血症组(n=248)和非低氧血症组(n=1351)。根据有无肺部疾病和低氧血症,将患者分为4组:有肺部疾病且低氧血症组(A组,n=136),有肺部疾病且无低氧血症组(B组,n=362),无肺部疾病且低氧血症组(C组,n=112),无肺部疾病且无低氧血症组(D组,n=989)。收集患者一般资料。采用SPSS 24.0软件对数据进行统计学分析。根据数据类型,组间比较采用独立样本t检验、单因素方差分析或χ^(2)检验。采用二分类多因素logistic回归分析老年髋部骨折患者发生低氧血症的危险因素。结果老年髋部骨折患者在急诊就诊时,约15.5%(248/1599)的患者存在低氧血症。与非低氧血症组相比,低氧血症组患者年龄更大、肺部疾病[54.8%(136/248)和26.8%(362/1351)]及心肌损伤[5.6%(14/248)和1.7%(23/1351)]发生率更高,差异有统计学意义(均P<0.05)。2组患者骨折发生情况比较,差异有统计学意义(P<0.01)。排除肺部疾病因素后,A组较B组患者年龄更大,股骨颈骨折发生率[66.9%(91/136)和47.8%(173/362)]更高,差异有统计学意义(P<0.01)。C组较D组患者D-二聚体水平及股骨颈骨折发生率[62.5%(70/112)和52.2%(516/989)]更高,差异有统计学意义(P<0.05)。多因素logistic回归分析显示,高龄、高D-二聚体水平、股骨颈骨折和肺部疾病是老年髋部骨折患者发生低氧血症的危险因素(OR=1.04,1.01,2.04,2.97;均P<0.05)。结论高龄、高D-二聚体水平、股骨颈骨折和肺部疾病是老年髋部骨折患者发生低氧血症的危险因素。合并低氧血症的老年髋部骨折患者,更易发生心肌损伤,可能会增加心血管不良事件。
Objective To investigate the status of hypoxia in the elderly patients with hip fracture at admission and analyze the related risk factors for hypoxia.Methods Clinical data of 1599 elderly patients with hip fracture treated in Jishuitan Hospital from May 2017 to March 2019 were collected and analyzed retrospectively.According to their oxygenation index and presence of pulmonary disease or not,the patients were divided into pulmonary disease+hypoxemia group(group A,n=136),pulmonary disease+non-hypoxemia group(group B,n=362),non-pulmonary disease+hypoxemia group(group C,n=112)and non-pulmonary disease and non-hypoxemia group(group D,n=989).SPSS statistics 24.0 used.Independent sample t test,one-way ANOVA or Chi-square test was adopted for intergroup comparison based on the data type.The risk factors of hypoxemia were analyzed by binary multivariate logistic regression in the elderly patients.Results About 15.5%(248/1599)of elderly patients with hip fracture had hypoxemia at the time of emergency treatment.The patients in the hypoxemia groups were significantly older and had obviously higher incidences of pulmonary diseases[54.8%(136/248)vs 26.8%(362/1351)]and myocardial injury[5.6%(14/248)and 1.7%(23/1351)]when compared with the non-hypoxemia groups(all P<0.05).There was significant difference in the incidence of fracture between the hypoxemia and non-hypoxemia groups(P<0.01).After exclusion of the factors of lung diseases,the patients in group A were older and had higher incidence of femoral neck fracture[66.9%(91/136)vs 47.8%(173/362)]than those in group B(P<0.01).The level of D-dimer and incidence of femoral neck fracture[62.5%(70/112)vs 52.2%(516/989)]were higher in the group C than the group D(P<0.05).Multivariate logistic regression analysis showed that older age,higher D-dimer level,femoral neck fracture and lung disease were the risk factors of hypoxemia in elderly patients with hip fracture(OR=1.04,1.01,2.04,2.97;all P<0.05).Conclusion Advanced age,high D-dimer level,femoral neck fracture and pulmonary dis
作者
刘肖
刘志伟
王梦琴
LIU Xiao;LIU Zhi-Wei;WANG Meng-Qin(Department of Emergency,Beijing Jishuitan Hospital,Beijing 100035,China)
出处
《中华老年多器官疾病杂志》
2021年第11期848-851,共4页
Chinese Journal of Multiple Organ Diseases in the Elderly
