膝髋关节置换术非计划性暂停手术的原因分析

发布时间：2018-02-26 05:04

  本文关键词： 膝关节 人工 关节成形术 置换 髋 暂停手术 术前管理 医疗效率　出处：《北京大学学报(医学版)》2017年02期 　论文类型：期刊论文

【摘要】：目的:分析择期膝、髋关节置换术前非计划性暂停手术的现状和原因,寻找其中的规律和共同性,为进一步优化择期膝、髋关节置换的患者术前管理,提高医疗资源的使用效率提供依据。方法:选择北京大学第三医院骨科2013年9月至2014年8月住院拟择期行膝、髋关节置换手术,但术前因故被暂停手术的病例资料,记录这些病例被暂停手术的原因,对其进行分析。结果:共拟行膝、髋关节置换手术1 146台,其中完成1 003台,因故暂停143台,停手术率达12.5%。暂停手术最常见的原因是心血管系统疾病(31%),其他部位感染(14%),菌尿(13%)和手术适应证不强(11%),其他导致手术暂停的原因还有血液系统检查异常、下肢静脉血栓、肝功能异常、血糖控制欠佳等。在不同性别的患者之间,停手术率差异无统计学意义(男性15.0%,女性11.6%,P=0.149),不同年龄段的患者之间,停手术率差异无统计学意义(≤50岁13.0%,51~65岁11.6%,66~80岁13.3%,80岁11.1%,P=0.864),但髋关节置换较膝关节置换更易被暂停手术(膝关节置换11.1%,髋关节置换16.1%,P=0.021)。结论:对于择期行膝、髋关节置换的患者进行恰当的术前教育和管理非常重要,通过明确诊断、细致的病史询问和体格检查,以及有针对性的检查化验,尽量避免住院后暂停手术的发生,提高医疗资源的使用效率。
[Abstract]:Objective: to analyze the present situation and causes of unplanned suspension before elective knee and hip arthroplasty, and to find out the regularity and commonality in order to optimize the preoperative management of patients with selective knee and hip arthroplasty. Methods: from September 2013 to August 2014, the orthopaedic department of the third Hospital of Peking University was selected to perform knee and hip arthroplasty, but the operation was suspended before operation. The causes of the suspension were recorded and analyzed. Results: a total of 1,146 knee and hip replacement operations were performed, of which 1,003 were completed and 143 were suspended. The most common reasons for suspending surgery are cardiovascular diseases (31), infection in other parts (14), bacteriuria (1313) and the lack of indications for surgery. Other reasons leading to the suspension of surgery include abnormal blood system examination and venous thrombosis in the lower extremity. Abnormal liver function, poor blood glucose control and so on. There was no significant difference in the rate of stopping surgery among patients of different gender (male 15.0, female 11.6T 0.149, age group 0.149, male 15.0, female 11.6T 0.149, P < 0.05). There was no significant difference in the rate of discontinuation of operation (鈮，

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