高龄骨科手术患者术后并发症发生的影响因素分析
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摘要
目的分析影响高龄骨科手术患者术后并发症发生的危险因素。方法我院296例高龄骨科手术患者,根据术后是否发生并发症,分为并发症组(n=59)和无并发症组(n=237),比较两组临床资料差异,分析影响高龄骨科手术患者术后并发症发生的危险因素。结果并发症组年龄≥85岁,合并高血压、冠心病、脑血管疾病、呼吸系统疾病,NYHA分级Ⅲ～Ⅳ级,白蛋白<35 g/L,血红蛋白<110 g/L,ASA分级≥Ⅲ级,手术时间≥2 h,输血患者比例均高于无并发症组(P <0. 05)。Logistic回归分析显示:合并呼吸系统疾病、NYHA分级Ⅲ～Ⅳ级、白蛋白<35 g/L、ASA分级≥Ⅲ级、输血是影响影响高龄骨科手术患者术后并发症发生的独立危险因素(P <0. 05)。结论高龄骨科手术患者术后并发症发生率较高,合并呼吸系统疾病、NYHA分级Ⅲ～Ⅳ级、白蛋白<35 g/L、ASA分级≥Ⅲ级、输血将增加高龄骨科手术患者并发症发生风险。
Objective To analyze the risk factors affecting postoperative complications in elderly patients with orthopedic surgery.Methods The clinical data of 296 elderly patients undergoing orthopedic surgery in our hospital were retrospectively analyzed.According to the presence or absence of postoperative complications,the patients were divided into complication group( n = 59) and noncomplication group( n = 237).The differences in clinical data were compared between the two groups.Risk factors for occurrence of postoperative complications in the patients were analyzed.Results The proportions of patients with age ≥ 85 years old,combined hypertension,coronary heart disease,cerebrovascular disease and respiratory disease,NYHA grade III ～ IV,albumin < 35 g/L,hemoglobin < 110 g/L,ASA grade ≥ grade III,operative time ≥ 2 h and blood transfusion in the complication group were significantly higher than those in the non-complication group( P < 0. 05).The logistic regression analysis showed that combined respiratory disease,NYHA grade III ～IV,albumin < 35 g/L,ASA grade ≥ III and blood transfusion were independent risk factors affecting postoperative complications in these patients( P < 0. 05).Conclusion The incidence rate of postoperative complications is high in elderly patients with orthopedic surgery.Combined respiratory disease,NYHA grade III ～ IV,albumin < 35 g/L,ASA grade ≥ III and blood transfusion may increase the risk of complications in these patients.
Objective To analyze the risk factors affecting postoperative complications in elderly patients with orthopedic surgery.Methods The clinical data of 296 elderly patients undergoing orthopedic surgery in our hospital were retrospectively analyzed.According to the presence or absence of postoperative complications,the patients were divided into complication group( n = 59) and noncomplication group( n = 237).The differences in clinical data were compared between the two groups.Risk factors for occurrence of postoperative complications in the patients were analyzed.Results The proportions of patients with age ≥ 85 years old,combined hypertension,coronary heart disease,cerebrovascular disease and respiratory disease,NYHA grade III ～ IV,albumin < 35 g/L,hemoglobin < 110 g/L,ASA grade ≥ grade III,operative time ≥ 2 h and blood transfusion in the complication group were significantly higher than those in the non-complication group( P < 0. 05).The logistic regression analysis showed that combined respiratory disease,NYHA grade III ～IV,albumin < 35 g/L,ASA grade ≥ III and blood transfusion were independent risk factors affecting postoperative complications in these patients( P < 0. 05).Conclusion The incidence rate of postoperative complications is high in elderly patients with orthopedic surgery.Combined respiratory disease,NYHA grade III ～ IV,albumin < 35 g/L,ASA grade ≥ III and blood transfusion may increase the risk of complications in these patients.
引文
[1]何健飞,姜世平,王建云,等.E-PASS评分系统对骨科高龄髋部手术风险评估的应用分析[J].中国医师进修杂志,2015,38(9):671-674.
[2]汪军.3种内固定方法治疗老年骨质疏松性股骨粗隆间骨折的疗效对比[J].成都医学院学报,2015,10(3):354-356.
[3]Cook RW,Weiner JA,Schallmo MS,et al.Effects of Conflicts of Interest on Practice Patterns and Complication Rates in Spine Surgery[J].Spine(Phila Pa 1976),2017,42(17):1322-1329.
[4]邓小明.现代麻醉学[M].第4版.北京:人民卫生出版社,2014:910-914.
[5] Luksanapruksa P,Buchowski JM,Zebala LP,et al. Perioperative Complications of Spinal Metastases Surgery[J]. Clin Spine Surg.2017,30(1):4-13.
[6]吴磊,蒋毅,吴京亮,等.髋部骨折术后内科并发症的评估及预测[J].中华全科医师杂志,2016,15(3):190-193.
[7]Chughtai M,Gwam CU,Mohamed N,et al. The Epidemiology and Risk Factors for Postoperative Pneumonia[J].J Clin Med Res,2017,9(6):466-475.
[8]李书闻,金沐,史晨辉,等.骨科高龄手术患者104例预后相关因素分析[J].中国医药,2014,9(5):694-698.
[9]王军霞,徐艳芳,丁楠,等.骨科患者术后死亡及并发症相关因素分析与护理对策[J].中华现代护理杂志,2014,20(22):2801-2803.
[10]余江,蒋科,吴思宇,等.骨科老年患者围手术期并发症相关危险因素评估[J].第三军医大学学报,2013,35(11):1160-1163.
[11]赵新华,袁航,钱金黔,等.后路椎体间融合术治疗复发性腰椎间盘突出症围手术期并发症及其危险因素[J].中华骨科杂志,2016,36(17):1121-1125.
[12]刘刚,袁东堂,于广洋,等.髋关节置换术后中位生存时间及相关预后影响因素分析[J].实用骨科杂志,2016,22(1):28-32.
[13]尚修帅,王祥,顾剑华,等.胫腓骨开放骨折外固定改内固定后发生并发症的影响因素[J].临床骨科杂志,2016,19(6):732-734.
[14]Kreindler SA,Siragusa L,Bohm E,et al. Regional consolidation of orthopedic surgery:impacts on hip fracture surgery access and outcomes[J].Can J Surg,2017,60(5):349-354.
[2]汪军.3种内固定方法治疗老年骨质疏松性股骨粗隆间骨折的疗效对比[J].成都医学院学报,2015,10(3):354-356.
[3]Cook RW,Weiner JA,Schallmo MS,et al.Effects of Conflicts of Interest on Practice Patterns and Complication Rates in Spine Surgery[J].Spine(Phila Pa 1976),2017,42(17):1322-1329.
[4]邓小明.现代麻醉学[M].第4版.北京:人民卫生出版社,2014:910-914.
[5] Luksanapruksa P,Buchowski JM,Zebala LP,et al. Perioperative Complications of Spinal Metastases Surgery[J]. Clin Spine Surg.2017,30(1):4-13.
[6]吴磊,蒋毅,吴京亮,等.髋部骨折术后内科并发症的评估及预测[J].中华全科医师杂志,2016,15(3):190-193.
[7]Chughtai M,Gwam CU,Mohamed N,et al. The Epidemiology and Risk Factors for Postoperative Pneumonia[J].J Clin Med Res,2017,9(6):466-475.
[8]李书闻,金沐,史晨辉,等.骨科高龄手术患者104例预后相关因素分析[J].中国医药,2014,9(5):694-698.
[9]王军霞,徐艳芳,丁楠,等.骨科患者术后死亡及并发症相关因素分析与护理对策[J].中华现代护理杂志,2014,20(22):2801-2803.
[10]余江,蒋科,吴思宇,等.骨科老年患者围手术期并发症相关危险因素评估[J].第三军医大学学报,2013,35(11):1160-1163.
[11]赵新华,袁航,钱金黔,等.后路椎体间融合术治疗复发性腰椎间盘突出症围手术期并发症及其危险因素[J].中华骨科杂志,2016,36(17):1121-1125.
[12]刘刚,袁东堂,于广洋,等.髋关节置换术后中位生存时间及相关预后影响因素分析[J].实用骨科杂志,2016,22(1):28-32.
[13]尚修帅,王祥,顾剑华,等.胫腓骨开放骨折外固定改内固定后发生并发症的影响因素[J].临床骨科杂志,2016,19(6):732-734.
[14]Kreindler SA,Siragusa L,Bohm E,et al. Regional consolidation of orthopedic surgery:impacts on hip fracture surgery access and outcomes[J].Can J Surg,2017,60(5):349-354.