诺顿量表评估老年患者脊柱骨折术后并发症风险

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英文篇名：Evaluating the risk of post-operative complications following spine fracture surgery in the elderly by Norton scale scores 作者：苏燕 ; 第荣静 英文作者：Su Yan;Di Rong-jing;Department of Orthopedics, Tongji hospital,Tongji University School of Medicine; 关键词：脊柱骨折 ; 诺顿评分 ; 术后并发症 ; 压疮 英文关键词：Spine fracture;;Norton scale;;Post-operative complications;;Pressure ulcers 中文刊名：SLHL 英文刊名：Journal of Clinic Nursing's Practicality 机构：上海市同济大学医学院/上海市同济医院骨科; 出版日期：2018-06-27 出版单位：实用临床护理学电子杂志 年：2018 期：v.3 语种：中文; 页：SLHL201826004 页数：3 CN：26 ISSN：11-9369/R 分类号：11-12+15

摘要

目的探讨诺顿量表(Norton)是否可用于老年脊柱骨折手术患者术后并发症风险评估。方法收集2012年1月至2014年1月在我院接受脊柱骨折手术的老年患者(年龄≥65岁)的资料,回顾性分析患者入院当日诺顿量表评分(Norton scale scores,ANSS)与人口学资料、术前合并症和术后并发症的关系。结果收集患者83例,年龄78.07±0.89岁,女性53例(63.9%)。腰椎骨折和胸椎骨折分别为46例(55.5%)和24例(28.9%)。其中,19例(22.89%)患者累计发生了33次压疮以外的术后并发症(急性冠脉综合征、肺炎、尿路感染和伤口感染)。入院当日ANSS评分中位数为17(四分位数,14-19),低ANSS组(<15分)为28例(33.73%)。低ANSS组患者发生术后并发症(压疮除外)的次数显著高于高ANSS组[1.0(IQR,0-2)vs 0(IQR,0-0),p=0.0017]。在术后并发症(压疮除外)中,尿路感染和ANSS有相关性(p<0.0001)。二元回归分析显示,入院当日ANSS是老年脊柱骨折患者术后发生并发症的独立危险因素(p<0.0001)。结论诺顿量表可能"老表新用",用于老年脊柱骨折术后并发症的风险评估。
        Objective To investigate if the admission Norton scale scores(ANSS)is applicable to evacuate the risk of post-operative complications following spine fracture surgery in the elderly. Methods This was a retrospective cross-sectional study which carried out at the division of orthopedic surgery in our Hospital between January 2012 and January 2014. The medical charts of consecutive elderly(≥65 years)patients admitted for spine fracture surgery were analyzed for the following measurements: ANSS,demographic data, co-morbidities, and post-operative complications. Results 83 patients were enrolled in the final study, with 53(63.9%) females and 30(36.1%) males. Mean age for the total cohort was 78.07±0.89 years.Most patients suffered from lumbar fractures(n = 46; 55.5%) or thoracal fractures(n = 24; 28.9%). 33 post-operation complications other than pressure ulcer, such as acute coronary syndrome, pneumonia,urinary tract infection and wound infection, were observed in 19(22.89%)of the entire cohort. The median of admission ANSS was 17(IQR,14-19) for the overall cohort and 28(33.73%) of them had low(<15)ANSS. Patients of low ANSS had significantly more post-operative complications in comparison with patients of high ANSS [1.0(IQR,0-2)vs 0(IQR,0-0),p =0.0017]. Among all post-operative complications, urinary tract infection was independently associated with ANSS(p < 0.0001). Binary regression analysis found that ANSS were independently associated with post-operative complications(p <0.0001). Conclusion Based on the findings of the present study that low ANSS are associated with post-operative complications,the Norton scoring system may be used for predicting postoperative complications in elderly patients following spine fracture surgery.

引文

[1]Fu KM,Smith JS,Polly DW,et al.Morbidity and mortality in the surgical treatment of 10,329 adults with degenerative lumbar stenosis.[J].J Neurosurg Spine,2010,(12):443-6.
    [2]Norton D.Calculating the risk:reflections on the Norton Scale.[J].Decubitus,1989,(2):24-31.
    [3]Ellis G,Langhorne P.Comprehensive geriatric assessment for older hospital patients.[J].Br.Med.Bull,2005,71:45-59.
    [4].Szczepanik AM,Brzuszkiewicz K,Walewska E,et al.Perioperative risk assessment tailored to elderly patients.[J].Pol Merkur Lekarski,2014,37(219):186-191.
    [5]Kim KI,Park KH,Koo KH,et al.Comprehensive geriatric assessment can predict postoperative morbidity and mortality in elderly patients undergoing elective surgery.[J].Arch Gerontol Geriatr,2013,56(3):507-512.
    [6]Dewan SK,Zheng SB,Xia SJ,et al.Preoperative geriatric assessment:comprehensive,multidisciplinary and proactive.[J].Eur J Intern Med,2012,23(6):487-494.
    [7]Ronen Sever,Aviram Gold,Ortal Segal,et al.Admission Norton scale scores(ANSS)are associated with post-operative complications following spine fracture surgery in the elderly.[J].Archives of Gerontology and Geriatrics,2012,(55):177-180.
    [8]Gold A,Sever R,Lerman Y,et al.Admission Norton scale scores(ANSS)and post-operative complications following hip fracture surgery in the elderly.[J].Arch.Gerontol.Geriatr,2012,(55):173-176.
    [9]Leshem-Rubinow E,Vaknin A,Sherman S,et al.Norton scale,hospitalization length,complications,and mortality in elderly patients admitted to internal medicine departments.[J].Gerontology,2013,59(6):507-513.