老年髋部骨折术后心力衰竭相关因素分析

Analysis of risk factors of postoperative heart failure in the elderly receiving operation for hip fracture

摘要:

目的 探讨影响老年髋部骨折术后发生心力衰竭的相关危险因素。方法 回顾性分析2010年6月至2013年12月在北京市丰盛中医骨伤医院采用手术治疗的老年髋部骨折(年龄≥70岁)患者329例,根据术后是否发生心力衰竭将329例患者分为2组:发生心力衰竭组(n=53)和未发生心力衰竭组(n=276),比较2组患者临床特点。采用SPSS 17.0统计软件进行数据处理。组间比较采用χ²检验。对单因素分析有统计学意义的指标进行多因素logistic 回归分析,筛选出独立的危险因素。结果 2组患者性别、手术时机、手术类型、高血压、2型糖尿病、低白蛋白血症差异无统计学意义(P＞0.05)。单因素分析结果表明年龄偏大、认知功能障碍、合并冠心病、贫血、术中输血多的髋部骨折患者术后易发生心力衰竭(P＜0.05)。多因素logistic回归分析结果表明贫血(OR＝3.030,95%CI 1.325 ～6.932；P＝0.009)、认知功能障碍(OR＝5.707,95%CI 1.346～24.097；P＝0.018)和并发冠心病(OR＝3.653,95%CI 1.444～9.241；P＝0.006)是导致老年髋部骨折患者术后发生心力衰竭的独立危险因素。结论 贫血、认知功能障碍和并发冠心病是老年髋部骨折术后发生心力衰竭的独立危险因素。

Abstract:

Objective To explore the risk factors of postoperative heart failure in the elderly who received operation for treatment of hip fracture. Methods Totally 329 patients (age>75 years) were analyzed who underwent operation for hip fracture in Beijing Fengsheng Special Hospital of Medical Traumatology and Orthopaedics from June 2010 to December 2013. They were divided into 2 groups:heart failure group (n=53), and non-heart failure group (n=276). The two groups were compared in their clinical features. SPSS statistics 17.0 was used for data processing, and χ² test for comparison. Logistic regression model was established to identify inde-pendent risk factors. Results No significant differences were found in gender, surgery occasion, surgery type, hypertension, type 2 diabetes mellitus and hypoalbuminemia between two groups(P＞0.05). Univariate analysis showed that patients with advanced age, cognitive dysfunction, complicated coronary heart disease, anemia, and intraoperative blood transfusion had higher risk of heart failure. Multivatiate logistic regression analysis revealed that anemia(OR＝3.030,5%CI 1.325-6.932; P＝0.009), cognitive dysfuction(OR＝5.707,5%CI 1.346-24.097; P＝0.018)and complicated coronary heart disease(OR＝3.653,5%CI 1.444-9.241; P＝0.006)were independent risk factors for postoperative heart failure. Conclusion Independent risk factors of heart failure in the elderly receiving operation for hip fracture include preoperative anemia, postoperative cognitive dysfunction and coronary heart disease.