作　　者： (陈敏敏）; (张艳华）; (杜艳萍）; (洪维）; (唐文菁）; (李慧林）; (程群）; (郑松柏）;

机构地区： 复旦大学附属华东医院骨质疏松科,上海200040 上海市老年医学研究所骨代谢研究室,上海200040 复旦大学老年医学中心,上海200040

出　　处： 《中华健康管理学杂志》 2017年第4期325-332,共8页

摘　　要： 目的 探讨影响老年髋部骨折围手术期并发症及术后死亡发生的相关危险因素.方法回顾性分析复旦大学附属华东医院2010年1月至2015年6月采用手术治疗的1352例老年（年龄≥65岁）髋部骨折患者资料,统计围手术期并发症及术后死亡发生可能的影响因素.结果患者性别、术前血清白蛋白水平低、美国麻醉医师学会（ASA）分级≥Ⅲ级、心功能≥Ⅲ级、围手术期输血、术前合并呼吸系统疾病是老年髋部骨折患者围手术期并发症发生的危险因素,其中性别（B值=-0.686,P=0.019）、术前血清白蛋白水平低（B值=-0.808,P=0.006）、心功能≥Ⅲ级（B值=1.181,P=0.004）、围手术期输血（B值=0.890,P=0.004）、术前合并呼吸系统疾病（B值=3.118,P=0.000）是围手术期并发症发生的独立危险因素.术前血清白蛋白水平低、ASA分级≥Ⅲ级、心功能≥Ⅲ级、围手术期输血是老年髋部骨折患者术后死亡发生的危险因素,其中术前血清白蛋白水平低（B值=-2.516,P=0.000）、围手术期输血（B值=1.396,P=0.010）是术后死亡发生的独立危险因素.结论老年髋部骨折患者围手术期并发症和术后死亡的发生是多种因素综合作用的结果,围手术期并发症的独立危险因素包括性别、术前血清白蛋白水平低、心功能≥Ⅲ级、围手术期输血以及术前合并呼吸系统疾病;死亡的独立危险因素包括术前血清白蛋白水平低和围手术期输血.围手术期风险评估及相关风险的预防是患者良好预后的关键. Objective To analyze risk factors for the perioperative complications and death following hip fracture in the elderly. Methods The present study included 1352 elderly patients （≥65 years） who had received hip fracture surgery from January 2010 to June 2015 in Huadong hospital affiliated to Fudan University. Their clinical data were analyzed to determine risk factors for perioperative complications and death. Results Factors significantly affecting the perioperative complications included gender, preoperative serum albumin, ASA grade （≥Ⅲ）, cardiac functional grade （≥Ⅲ）, respiratory system disease and blood transfusion. Factors significantly affecting the death included preoperative serum albumin, ASA grade （≥Ⅲ）, cardiac functional grade （≥Ⅲ） and blood transfusion. Multivariate Logistic regression analysis revealed that the independent risk factors for perioperative complications included gender （B=-0.686, P=0.019）, preoperative serum albumin （B=-0.808, P=0.006）, cardiac functional grade （≥Ⅲ, B=1.181, P=0.004）, blood transfusion （B=0.890, P=0.004） and respiratory system disease （B=3.118, P=0.000）;while the independent risk factors for death included preoperative serum albumin （B=-2.516, P=0.000） and blood transfusion （B=1.396, P=0.010）. Conclusions In elderly patients undergoing hip fracture surgery, the independent risk factors for perioperative complications included gender, preoperative serum albumin, cardiac functional grade, blood transfusion and respiratory system disease, while the independent risk factors for death included preoperative serum albumin and blood transfusion. Perioperative risk assessment and prevention are the keys of better prognosis.

关 键 词： 老年人 髋骨折 手术中并发症 死亡 危险因素