老年股骨粗隆间骨折内固定术后进入ICU的危险因素△（开放获取）

Risk factors for intensive care unit stay after proximal femoral nail anti-rotation for femoral intertrochanteric fractures in elderly

摘要:

[目的]探讨老年股骨粗隆间骨折患者术后进入重病监护病房（intensivecareunit,ICU）的危险因素。[方法]回顾性分析2013年1月—2018年8月在本院接受手术治疗的437例老年股骨粗隆间骨折患者的临床资料。根据术后是否进入 ICU，将其分为ICU组和非ICU组。采用单项因素比较以及多因素二元逻辑回归分析法探索患者术后进入ICU的危险因素。 [结果]437例患者中，进入ICU66例，占15.1%；未进入ICU371例，占84.9%。单项因素比较显示：ICU组患者合并脑血管疾病占比（15.2%vs6.5%,P=0.015）、合并老年痴呆占比（6.1%vs1.1%,P=0.021）、ASA分级≥3级占比（48.5%vs24.0%,P＜ 0.001）、全身麻醉占比（80.3%vs18.9%,P＜0.001）显著高于非ICU组，但是，两组在性别构成、年龄、BMI、其他常见内科合并症（包括合并糖尿病、慢性肾病、慢性肺病、冠心病、肿瘤）、损伤至手术时间、骨折AO分型、术前检验、术中失血量、 术中输血比例、手术时间的差异均无统计学意义（P＞0.05）。多因素二元逻辑回归分析显示：全身麻醉（OR=18.970,95%CI: 9.560~37.640,P＜0.001）、ASA分级≥3级（OR=3.553,95%CI:1.856~6.799,P＜0.001）是老年股骨粗隆间骨折内固定术后进入ICU 的独立危险因素。[结论]全身麻醉和ASA分级≥3级是老年股骨粗隆间骨折内固定术后进入ICU的独立危险因素。

Abstract:

[Objective] To search the risk factors for intensive care unit (ICU) stay after proximal femoral nail anti-rotation (PFNA) for femoral intertrochanteric fractures in the elderly. [Methods] A retrospective study was conducted on 437 elderly patients who received PFNA for femoral intertrochanteric fractures in our hospital from January 2013 to August 2018. According to whether the patients had ICU stay after operation, they were divided into ICU group and non-ICU group. Univariate comparison and multi-factor binary logistic regression analysis were used to explore the risk factors related to ICU stay after surgery. [Results] Among the 437 patients, 66 patients had ICU stay, accounting for 15.1%, whereas the remaining 371 patients had no ICU stay, accounting for 84.9%. As results of univariate comparison, the ICU group proved significantly greater than the non-ICU group in terms of proportions of cerebrovascular disease (15.2% vs 6.5%, P= 0.015), Alzheimer's disease (6.1% vs 1.1%, P=0.021), ASA grade ≥3 (48.5% vs 24.0%, P＜0.001) and general anesthesia (80.3% vs 18.9%, P＜0.001). However, there were no statistically significant differences between the two groups in gender composition, age, BMI and other common medical complications, including diabetes mellitus, chronic kidney disease, chronic lung disease, coronary heart disease, tumor, as well as interval from injury to operation, AO classification of the fracture, preoperative examination parameters, intraoperative blood loss, intraoperative blood transfusion ratio, and operation time (P＞0.05). As for Multi-factor binary logistic regression analysis, the general anesthesia (OR=18.970, 95%CI: 9.560~37.640, P＜0.001) and ASA grade ≥3 (OR=3.553, 95%CI: 1.856~6.799, P＜0.001) were independent risk factors for ICU stay after internal fixation of femoral intertrochanteric fractures in the elderly. [Conclusion] General anesthesia and ASA grade ≥3 are independent risk factors for ICU stay after internal fixation of femoral intertrochanteric fractures in the elderly.