老年髋部骨折术后并发症发生风险与贫血的相关性研究

Risk for postoperative complications in the elderly with hip fracture and its correlation with anemia

摘要:

目的 研究老年髋部骨折患者术后并发症与贫血的关系，从而进一步探讨贫血能否作为预测老年髋部骨折并发症的独立危险因素。方法 从解放军总医院髋部骨折数据库中纳入2009年10月1日至2011年10月1日之间入院、年龄≥50岁且髋部骨折经手术治疗的患者744例。根据入院后首次血红蛋白检测值区分为贫血组和非贫血组，收集患者一般临床资料，运用多因素logistic回归分析术后并发症与贫血的关系。结果 贫血组患者年龄、输血患者数、粗隆间骨折患者数和采用髓内固定患者数均显著高于非贫血组，差异具有统计学意义（P＜0.05）；贫血组发生术后并发症患者数、发生呼吸系统并发症和发热的患者数均显著高于非贫血组，差异具有统计学意义（P＜0.05）；校正年龄、性别、美国麻醉医师协会（ASA）评分等危险因素后，贫血增加了患者术后呼吸系统并发症、术后发热的发病风险（P＜0.05）。另外，贫血显著增加了女性骨折患者术后总体并发症的发病风险（P＜0.05）。结论 贫血可作为老年髋部骨折患者术后呼吸系统并发症及术后发热的独立危险因素；对于发生髋部骨折的女性患者，贫血是预测术后总体并发症风险的独立危险因素。

Abstract:

Objective To investigate the relationship between the occurrence of postoperative complications and anemia in the elderly with hip fracture, and to further determine whether anemia is a risk factor for predicting the complications after hip fracture. Methods A total of 744 hip fracture patients aged over 50 years undergoing hip fracture surgery in our hospital over the period of October 1, 2009 to October 1, 2011 were enrolled in this study from the hip fracture data of the Chinese PLA General Hospital. Their clinical data were collected and retrospectively studied. The cohort was divided into anemia and non-anemia groups based on the hemoglobin level on admission. Multivariate logistic regression analysis was applied to assess the association between anemia and the complications. Results The age was older, and the constituent ratios of patients receiving blood transfusion, having intertrochanteric fracture and undergoing intramedullary fixation treatment were significantly higher in the anemia group than in the non-anemia group (P＜0.05). There were more patients having fever, postoperative complications and respiratory complications in the former than in the latter groups (P＜0.05). After adjustment for age, sex, American Society of Anesthesiologists (ASA) physical status classification score and other risk factors, logistic regression analysis showed that anemia increased the risk for postoperative fever and pulmonary complications (P＜0.05), and it also significantly increased the incidence of postoperative overall complications in female patients (P＜0.05) . Conclusion Anemia is an independent risk factor for pulmonary complications and postoperative fever after hip fracture in the elderly. And for the female elderly, it is also an independent risk factor for overall complications.