【摘要】：研究目的 通過研究高齡骨科手術(shù)患者術(shù)前術(shù)中一般情況及術(shù)前化驗指標(biāo)與常見術(shù)后并發(fā)癥發(fā)生的相關(guān)性,探討高齡骨科手術(shù)患者常見術(shù)后并發(fā)癥發(fā)生的影響因素。 研究方法 本研究通過收集2003年7月1日至2013年12月31日期間,在中國中醫(yī)科學(xué)院望京醫(yī)院骨科就診并接受手術(shù)治療的502例80歲以上高齡老年患者的病歷資料,建立Excel數(shù)據(jù)庫,先進行描述性統(tǒng)計,然后用SPSS17.0對發(fā)生率在10%以上的五種術(shù)后并發(fā)癥進行l(wèi)ogistic回歸分析,篩選出與此并發(fā)癥相關(guān)的影響因素。 研究結(jié)果 本組高齡骨科手術(shù)患者男女患者比例為1：1.95；80歲～84歲年齡段患者占65.94%；平均住院時間為26.76±16.95天；發(fā)病后1天以內(nèi)入院者占42.63%；入院后在4～7天間進行手術(shù)的病例占46.41%；病因以意外傷害為主占83.07%；疾病種類骨折患者占85.06%；最常見的病變部位為髖關(guān)節(jié)占65.34%；術(shù)前有合并癥的占57.77%。手術(shù)類型以行關(guān)節(jié)置換術(shù)與髓內(nèi)針內(nèi)固定術(shù)的病例分別占33.47%、33.07%；手術(shù)時間在1-2小時之間的病例占56.97%；術(shù)中出血量在200ml以內(nèi)占50.20%；麻醉方式以椎管內(nèi)麻醉為主,占63.94%。 術(shù)后共有377例患者出現(xiàn)了并發(fā)癥,發(fā)生率為75.10%；死亡6人,死亡率為1.20%；對術(shù)后并發(fā)癥按發(fā)生率排序,從高到底的分別是貧血、低蛋白血癥、肺部感染、低鉀血癥、低鈉血癥、泌尿系感染、下肢深靜脈血栓、低氯血癥、應(yīng)激性潰瘍、呼吸衰竭；所有患者住院期間中藥使用率為80.28%。 Logistic回歸分析顯示,高齡骨科手術(shù)患者術(shù)后貧血發(fā)生的影響因素主要有中藥使用、手術(shù)方式、麻醉方式等；術(shù)后低蛋白血癥發(fā)生的影響因素主要有術(shù)前血鈣、中藥使用、既往高血壓等；術(shù)后肺部感染發(fā)生的影響因素主要有既往慢性支氣管炎、中藥使用、術(shù)前血鉀等；術(shù)后低鉀血癥發(fā)生的影響因素主要有性別、術(shù)前紅細胞計數(shù)、中藥使用等；術(shù)后低鈉血癥發(fā)生的影響因素主要有術(shù)前血鈣、受傷部位、中藥使用等。 結(jié)論 4.1中藥使用對術(shù)后并發(fā)癥的發(fā)生可能有預(yù)防作用； 4.2高齡骨科手術(shù)患者以女性及80-84歲年齡段人數(shù)為主；高齡骨科手術(shù)患者發(fā)病原因以意外傷害為主,疾病種類以骨折為多,病變部位以髖關(guān)節(jié)(股骨近端)為首； 4.3既往慢性支氣管炎病史可能是高齡骨科手術(shù)患者術(shù)后肺部感染發(fā)生的高危因素 4.4血鈣、白蛋白可能是預(yù)測高齡骨科手術(shù)患者術(shù)后并發(fā)癥發(fā)生有意義的指標(biāo)； 4.5手術(shù)方式、麻醉方式可能對高齡骨科手術(shù)患者術(shù)后并發(fā)癥的發(fā)生有影響。
[Abstract]:Objective to explore the influencing factors of common postoperative complications in elderly patients with orthopedic surgery by studying the relationship between the general situation of preoperative operation and the indexes of preoperative test and the occurrence of common postoperative complications in elderly patients with orthopedic surgery. Methods during the period from July 1, 2003 to December 31, 2013, 502 patients over 80 years old who were treated by orthopedic department of Wangjing Hospital, Chinese Academy of traditional Chinese Medicine, were collected. In order to establish Excel database, descriptive statistics were carried out first, and then logistic regression analysis was carried out for five postoperative complications with incidence rate of more than 10% by SPSS17.0 regression analysis, and the influencing factors were screened out. Results the proportion of male and female aged patients with orthopedic surgery was 1: 1.95% ~ 84 years old, the average hospitalization time was 26.76 鹵16.95 days, the proportion of patients admitted within 1 day after the onset of the disease was 42.63, and the average hospitalization time was 26.76 鹵16.95 days. 46.41 cases were operated on within 4 days after admission, 83.07 cases were mainly caused by accidental injury, 85.06 cases were treated with fracture of disease type, 65.3445% were located in hip joint, 57.77 cases had complications before operation. The types of operation were arthroplasty and intramedullary needle fixation, which accounted for 33.470.07, 56.97, 56.97, 50.20 and 63.94, respectively. A total of 377 patients had complications, the incidence rate was 75.100.The death rate was 1.20. the incidence of postoperative complications was in order of anemia, hypoproteinemia, pulmonary infection, hypokalemia, hyponatremia, and hyponatremia. Urinary tract infection, deep venous thrombosis of lower extremity, hypochloremia, stress ulcer, respiratory failure. The utilization rate of traditional Chinese medicine during hospitalization was 80.28. Logistic regression analysis showed, The main influencing factors of postoperative anemia in elderly patients with orthopedic surgery were the use of traditional Chinese medicine, the way of operation, the way of anesthesia, and so on, and the influencing factors of hypoproteinemia after operation were preoperative blood calcium, traditional Chinese medicine use, past hypertension and so on. The main influencing factors of postoperative pulmonary infection were chronic bronchitis, traditional Chinese medicine, preoperative blood potassium and so on, and the main influencing factors of postoperative hypokalemia were sex, red blood cell count before operation, use of traditional Chinese medicine and so on. The main influencing factors of hyponatremia after operation were preoperative blood calcium, injury site, traditional Chinese medicine use and so on. Conclusion 4.1 the use of traditional Chinese medicine may prevent the occurrence of postoperative complications, 4.2 elderly patients with orthopaedic surgery are mainly female and 80-84 years old, the main causes of the elderly patients with orthopaedic surgery are accidental injury. Most of the diseases were fracture, and the site of the disease was hip joint (proximal femur), 4.3 the history of chronic bronchitis may be the high risk factor of pulmonary infection in elderly patients with orthopedic surgery. Albumin may be a significant predictor of postoperative complications in elderly patients with orthopedic surgery, and 4.5 surgical methods and anesthesia may have an effect on the occurrence of postoperative complications in elderly patients with orthopedic surgery.
【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R687.3

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本文編號：2265941