老年髋部骨折患者术后新发心脏不良事件的危险因素

Risk factors for new cardiac adverse events in the elderly after hip fractureoperation

摘要:

目的 研究老年髋部骨折患者术后住院期间新发心脏不良事件的危险因素。方法 回顾性分析2014年7月至2018年6月在北京老年医院骨科所有住院的≥65岁的髋部骨折患者,收集所有患者的基线资料、术前合并症、麻醉方式等,分析其术后新发心脏不良事件的临床特点及危险因素。采用SPSS 22.0软件进行数据处理。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。结果 共纳入418例患者,住院(13.2±6.8)d,年龄(76.7±9.2)岁,住院期间新发心脏不良事件56例(发生事件组),发生率为13.4％,其中因心脏事件死亡3例,死亡率0.72%。未发生心脏不良事件362例(未发生事件组)。2组患者异常心电图、左室射血分数≥50%、血红蛋白≥90g/L、血清白蛋白≥33g/L、B型脑钠肽前体≥450pg/ml、全身麻醉、术后电解质紊乱比例比较,差异有统计学意义(P＜0.05)。多因素logistic回归分析显示,心血管系统疾病史(OR=13.58,95％CI 10.12~21.39；P<0.01)、合并≥4种内科基础疾病(除心血管系统)(OR=5.28,95％CI 1.21~15.25；P<0.01)、美国麻醉医师协会(ASA) Ⅲ/Ⅳ级(OR=4.01,95％CI 3.24~10.34；P＜0.01)、年龄≥70岁(OR=2.86,95％CI 1.05~7.55；P<0.05)、血清白蛋白＜33g/L (OR=2.61,95％CI 1.23~5.51；P<0.01)、血红蛋白＜90g/L(OR=1.81,95％CI 1.03~6.21；P<0.01)、术后电解质紊乱(OR=1.11,95％CI 1.02~2.34；P<0.01)是老年髋部骨折患者术后新发心脏不良事件独立危险因素。结论 老年髋部骨折术后发生心脏不良事件是多种因素共同作用的结果,对于既往有心血管系统疾病史的患者应给与特别关注。

Abstract:

Objective To study the risk factors for new cardiac adverse events during post-operative hospitalization in the elderly patients with hip fracture. Methods A retrospective analysis was conducted on the elderly patients over aged 65 years with hip fracture undergoing surgical treatment in Beijing Geriatric Hospital from July 2014 to June 2018. Their baseline data, preoperative complications and anesthetic modes were collected and analyzed for the clinical features and risk factors of new cardiac adverse events during hospitalization. The data were processed with SPSS statistics 22.0. Multivariate logistic regression analysis was used to analyze the statistically significant indices found by univariate logistic regress analysis. Results A total of 418 patients were enrolled in this study, and they are at a mean age of (76.7±9.2) years and had an average length of hospital stay of (13.2±6.8) d. There were 56 cases reporting new adverse cardiac events during hospitalization (13.4%, cardiac events group). Three patients died due to cardiac events, accounting for 0.72% (3/418). And the left 362 cases were assigned into the non-cardiac events group. Significant differences were seen in the ratios of patients with abnormal electrocardiogram, left ventricular ejection fraction ≥50%, hemoglobin ≥90g/L, albumin ≥33g/L, pro-B-type natriuretic peptide ≥450 pg/ml, general anesthesia and electrolyte disturbance after operation between the cardiac and non-cardiac events groups (P<0.05). Multivariate logistic analysis showed that the history of cardiovascular diseases (OR=13.58, 95%CI 10.12-21.39; P<0.01), combination of basic diseases of internal medicine (except cardiovascular system) >4 (OR=5.28,95%CI 1.21-15.25; P<0.01), ASA grade Ⅲ/Ⅳ(OR=4.01,95%CI 3.24-10.34; P<0.01), age >70 years(OR=2.86, 95%CI 1.05-7.55; P<0.05), serum albumin <33g/L (OR=2.61,95％CI 1.23-5.51; P<0.01), hemoglobin <90g/L (OR=1.81,95%CI 1.03-6.21; P<0.01), electrolyte disturbance (OR=1.11,95%CI:1.02-2.34; P<0.01) were independent risk factors for new cardiac adverse events in elderly patients after operation for hip fracture. Conclusion Cardiac adverse events after hip fracture surgery in the elderly are the result of multiple factors. Special attention should be paid to those with history of cardiovascular diseases.