502例高龄骨科手术患者术后并发症影响因素的回顾性研究

发布时间：2018-10-12 11:31

【摘要】：研究目的通过研究高龄骨科手术患者术前术中一般情况及术前化验指标与常见术后并发症发生的相关性,探讨高龄骨科手术患者常见术后并发症发生的影响因素。研究方法本研究通过收集2003年7月1日至2013年12月31日期间,在中国中医科学院望京医院骨科就诊并接受手术治疗的502例80岁以上高龄老年患者的病历资料,建立Excel数据库,先进行描述性统计,然后用SPSS17.0对发生率在10%以上的五种术后并发症进行logistic回归分析,筛选出与此并发症相关的影响因素。研究结果本组高龄骨科手术患者男女患者比例为1：1.95；80岁～84岁年龄段患者占65.94%；平均住院时间为26.76±16.95天；发病后1天以内入院者占42.63%；入院后在4～7天间进行手术的病例占46.41%；病因以意外伤害为主占83.07%；疾病种类骨折患者占85.06%；最常见的病变部位为髋关节占65.34%；术前有合并症的占57.77%。手术类型以行关节置换术与髓内针内固定术的病例分别占33.47%、33.07%；手术时间在1-2小时之间的病例占56.97%；术中出血量在200ml以内占50.20%；麻醉方式以椎管内麻醉为主,占63.94%。术后共有377例患者出现了并发症,发生率为75.10%；死亡6人,死亡率为1.20%；对术后并发症按发生率排序,从高到底的分别是贫血、低蛋白血症、肺部感染、低钾血症、低钠血症、泌尿系感染、下肢深静脉血栓、低氯血症、应激性溃疡、呼吸衰竭；所有患者住院期间中药使用率为80.28%。 Logistic回归分析显示,高龄骨科手术患者术后贫血发生的影响因素主要有中药使用、手术方式、麻醉方式等；术后低蛋白血症发生的影响因素主要有术前血钙、中药使用、既往高血压等；术后肺部感染发生的影响因素主要有既往慢性支气管炎、中药使用、术前血钾等；术后低钾血症发生的影响因素主要有性别、术前红细胞计数、中药使用等；术后低钠血症发生的影响因素主要有术前血钙、受伤部位、中药使用等。结论 4.1中药使用对术后并发症的发生可能有预防作用； 4.2高龄骨科手术患者以女性及80-84岁年龄段人数为主；高龄骨科手术患者发病原因以意外伤害为主,疾病种类以骨折为多,病变部位以髋关节(股骨近端)为首； 4.3既往慢性支气管炎病史可能是高龄骨科手术患者术后肺部感染发生的高危因素 4.4血钙、白蛋白可能是预测高龄骨科手术患者术后并发症发生有意义的指标； 4.5手术方式、麻醉方式可能对高龄骨科手术患者术后并发症的发生有影响。
[Abstract]:Objective to explore the influencing factors of common postoperative complications in elderly patients with orthopedic surgery by studying the relationship between the general situation of preoperative operation and the indexes of preoperative test and the occurrence of common postoperative complications in elderly patients with orthopedic surgery. Methods during the period from July 1, 2003 to December 31, 2013, 502 patients over 80 years old who were treated by orthopedic department of Wangjing Hospital, Chinese Academy of traditional Chinese Medicine, were collected. In order to establish Excel database, descriptive statistics were carried out first, and then logistic regression analysis was carried out for five postoperative complications with incidence rate of more than 10% by SPSS17.0 regression analysis, and the influencing factors were screened out. Results the proportion of male and female aged patients with orthopedic surgery was 1: 1.95% ~ 84 years old, the average hospitalization time was 26.76 卤16.95 days, the proportion of patients admitted within 1 day after the onset of the disease was 42.63, and the average hospitalization time was 26.76 卤16.95 days. 46.41 cases were operated on within 4 days after admission, 83.07 cases were mainly caused by accidental injury, 85.06 cases were treated with fracture of disease type, 65.3445% were located in hip joint, 57.77 cases had complications before operation. The types of operation were arthroplasty and intramedullary needle fixation, which accounted for 33.470.07, 56.97, 56.97, 50.20 and 63.94, respectively. A total of 377 patients had complications, the incidence rate was 75.100.The death rate was 1.20. the incidence of postoperative complications was in order of anemia, hypoproteinemia, pulmonary infection, hypokalemia, hyponatremia, and hyponatremia. Urinary tract infection, deep venous thrombosis of lower extremity, hypochloremia, stress ulcer, respiratory failure. The utilization rate of traditional Chinese medicine during hospitalization was 80.28. Logistic regression analysis showed, The main influencing factors of postoperative anemia in elderly patients with orthopedic surgery were the use of traditional Chinese medicine, the way of operation, the way of anesthesia, and so on, and the influencing factors of hypoproteinemia after operation were preoperative blood calcium, traditional Chinese medicine use, past hypertension and so on. The main influencing factors of postoperative pulmonary infection were chronic bronchitis, traditional Chinese medicine, preoperative blood potassium and so on, and the main influencing factors of postoperative hypokalemia were sex, red blood cell count before operation, use of traditional Chinese medicine and so on. The main influencing factors of hyponatremia after operation were preoperative blood calcium, injury site, traditional Chinese medicine use and so on. Conclusion 4.1 the use of traditional Chinese medicine may prevent the occurrence of postoperative complications, 4.2 elderly patients with orthopaedic surgery are mainly female and 80-84 years old, the main causes of the elderly patients with orthopaedic surgery are accidental injury. Most of the diseases were fracture, and the site of the disease was hip joint (proximal femur), 4.3 the history of chronic bronchitis may be the high risk factor of pulmonary infection in elderly patients with orthopedic surgery. Albumin may be a significant predictor of postoperative complications in elderly patients with orthopedic surgery, and 4.5 surgical methods and anesthesia may have an effect on the occurrence of postoperative complications in elderly patients with orthopedic surgery.
【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R687.3

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