老年髋部骨折术后死亡的危险因素△

Risk factors of death after surgical treatment for hip fractures in the elderly

摘要:

[目的]探讨老年髋部骨折手术后死亡的危险因素。[方法]回顾性分析 2017 年 1 月—2019 年 1 月于本院手术治疗的 177 例老年髋部骨折患者的临床资料，记录年龄、性别、临床检验、ADL (activities of daily living, ADL) 评分及生存情况等数据，按患者是否死亡分为生存组和死亡组，单因素分析两组各项指标，并行 Cox 生存分析。[结果] 177 例患者中，共 147 例获得完整随访，30 例失访，失访率为 16.95%。平均随访时间 (18.59±7.70) 个月，术后 1 年时生存 123 例，生存率为 83.67%；术后 2 年时生存 109 人，生存率为 74.15%。对 38 例患者的死亡病因分析，肺部感染为主要病因，占 44.74%，其次为心功能衰竭，占 31.58%。单因素分析表明：与生存组相比，死亡组患者的年龄更大、合并基础疾病数量更多、家庭陪护比例更低、术前的 ADL 评分更差且术前血红蛋白、白蛋白含量更少，差异具有统计学意义 (P＜0.05)。Cox 生存分析表明：家庭陪护(OR=0.382，P=0.008)、术前 ADL 评分(OR=0.982，P=0.023)、术前血红蛋白量(OR=0.978，P=0.004)和术前白蛋白量 (OR=0.845，P＜0.001) 为老年髋部骨折术后死亡的保护因素，而术前的基础疾病数量 (OR=3.926，P=0.002) 为老年髋部骨折术后死亡的危险因素。[结论]家庭陪护、术前 ADL 评分高、术前血红蛋白及白蛋白含量高是老年髋部骨折术后死亡的保护因素；而基础疾病数量多则是老年髋部骨折术后死亡的危险因素。

Abstract:

[Objective] To explore the risk factors of death after surgical treatment for hip fractures in the elderly. [Methods] A retro- spective study was conducted on 177 elderly patients who received surgical treatment for hip fractures in our hospital from January 2017 to January 2019. The general data, involving age, gender, clinical examination, activity of daily living (ADL) score and survival state were re- corded. Based on whether the patient died in 2 years, the patients was divided into two groups. Univariate comparison of the two groups and Cox survival regression were conducted to search the risk factors related to death. [Results] Among 177 patients, 147 cases were completely followed up, whereas 30 cases were lost to follow-up, accounted for 16.95%, in a mean follow-up period of (18.59±7.70) months. Of them, 123 patients survived at 1 year after operation with survival rate of 83.67%, and 109 patients survived at 2 years after operation with the sur- vival rate of 74.15%. In term of death causes of the 38 patients, pulmonary infection was the main cause, accounting for 44.74%, followed by cardiac failure, accounting for 31.58%. As results of univariate comparison, the patients in the death group were significantly older, had more complicated underlying diseases, lower proportion of family care, worse preoperative ADL score and lower preoperative hemoglobin and albumin than those of the survival group, which were statistically significant (P＜0.05) . In term of Cox survival regression, the family care (OR=0.382, P=0.008) , preoperative ADL score (OR=0.982, P=0.023) , preoperative hemoglobin (OR=0.978, P=0.004) and preopera- tive albumin (OR=0.845, P＜0.001) were protective factors, whereas the preoperative number of underlying diseases (OR=3.926, P=0.002) was a risk factor for death after surgical treatment for hip fractures in the elderly. [Conclusion] Family care, high preoperative ADL score, and high preoperative hemoglobin and albumin are the protective factors, while the number of underlying diseases is a risk factor for death after surgical treatment of hip fractures in the elderly.