老年髋部骨折入院血红蛋白水平与术后1年死亡率的相关性分析

发布时间：2018-05-12 07:42

  本文选题：髋部骨折 + 老年人　； 参考：《广州中医药大学》2017年硕士论文

【摘要】：目的:探讨老年髋部骨折患者入院血红蛋白水平与术后1年死亡率的相关性。方法:回顾性分析2013年1月至2015年12月在广东省中医院(广州中医药大学第二附属医院)接受手术治疗的老年髋部骨折患者(≥65岁)308例(男94例,女214例,平均80.20±6.39岁),准确记录其基本个人信息、性别、年龄、骨折类型、术前中医证型、入院合并症、入院血红蛋白水平、ASA评级、手术方式、麻醉方式、术中出血量、手术时间,通过电话或门诊随访术后1年内生存情况。对存活状态的影响因素进行单因素分析,采用χ2检验(包括Fisher精确检验、R×C列联表χ2检验),检验水平为P0.05。把单因素分析证实有统计学差异的自变量带入二分类Logistic回归模型进行多因素分析,P0.05为有统计学意义。结果:本研究共纳入308例患者,其中男性94例(30.5%),女性214例(69.5%),平均年龄80.20±6.39岁,存活269例(87.3%),死亡39例(12.7%),住院期间死亡2例(0.6%),死亡患者平均年龄82.90±6.00岁,存活患者平均年龄79.81 ±6.35岁;骨折类型:股骨颈骨折137例(44.5%),股骨粗隆间骨折171例(55.50%);术前中医证型:肝肾亏虚证,气滞血瘀证218例(70.8%),气血两虚证72例(23.40%),痰瘀蕴结证18例(5.8%);入院前合并症:合并症≤2种183例(59.4%),合并症2种125例(40.6%);入院血红蛋白水平:114.62± 17.64g/L;ASA评级:术前ASA评级为Ⅰ、Ⅱ级190例(61.7%),Ⅲ、Ⅳ级118例(38.3%);麻醉方式:椎管内麻醉277例(89.9%),全麻31例(10.1%);手术方式:行人工关节置换术141例(45.8%),髓内内固定术115例(37.3%),髓外内固定及其他固定形式52例(16.9%);术中出血量:手术中平均出血184.17±145.30ml;手术时间:平均93.08±31.86分钟。单因素分析显示年龄、术前中医证型、合并症、入院血红蛋白水平、ASA评级是老年髋部骨折术后1年死亡的危险因素(P0.05);二分类Logisti回归模型进行多因素分析显示入院血红蛋白水平(P=0.043,OR=0.625,CI:0.396～0.985)和ASA评级(P=0.021,OR=0.424,CI:0.205～0.877)是老年髋部骨折患者术后1年死亡的独立危险因素。结论:影响老年髋部骨折术后1年死亡率的危险因素有多种,本研究显示,年龄、术前中医证型、合并症、入院血红蛋白水平、ASA评级是老年髋部骨折术后1年死亡的危险因素,其中入院血红蛋白水平和ASA评级是影响术后1年死亡率的独立危险因素。临床医师应重视老年髋部骨折术前评估及围手术期管理,配合中医辨证论治,提高患者临床疗效以降低死亡率。
[Abstract]:Objective: to investigate the correlation between hemoglobin level and 1-year postoperative mortality in elderly patients with hip fracture. Methods: from January 2013 to December 2015, 308 elderly patients with hip fractures (94 males and 214 females) received surgical treatment in Guangdong Provincial Hospital of traditional Chinese Medicine (second affiliated Hospital of Guangzhou University of traditional Chinese Medicine) were retrospectively analyzed. The average age was 80.20 卤6.39 years old. The basic personal information, sex, age, fracture type, preoperative TCM syndrome type, admission complication, admission hemoglobin level, ASA rating, operation mode, anesthetic method, intraoperative bleeding volume, operative time were recorded accurately. All patients were followed up by telephone or outpatient within 1 year after operation. Univariate analysis was carried out on the influencing factors of survival state. 蠂 2 test (including Fisher accurate test) was used to test R 脳 C table 蠂 2 test, the test level was P0.05. Univariate analysis confirmed that there was statistical difference between independent variables into the two-classification Logistic regression model for multivariate analysis (P0.05) for statistical significance. Results: a total of 308 patients were included in this study, of whom 94 were male (30.5) and 214 were female (69.559), with an average age of 80.20 卤6.39 years old, 269 survival cases with 87.3 years of age, 39 cases with death of 12.7T, 2 cases with death during hospitalization, with an average age of 82.90 卤6.00 years and an average age of 79.81 卤6.35 years. Fracture type: 137 cases of femoral neck fracture and 171 cases of femoral intertrochanteric fracture. Qi stagnation and blood stasis syndrome, Qi stagnation and blood stasis syndrome in 218 cases, Qi and blood deficiency syndrome in 72 cases, phlegm and stasis accumulation syndrome in 18 cases, prehospital complications: complication 鈮，

本文编号：1877742