發(fā)布時(shí)間：2018-05-12 07:42

  本文選題：髖部骨折 + 老年人��； 參考：《廣州中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的:探討老年髖部骨折患者入院血紅蛋白水平與術(shù)后1年死亡率的相關(guān)性。方法:回顧性分析2013年1月至2015年12月在廣東省中醫(yī)院(廣州中醫(yī)藥大學(xué)第二附屬醫(yī)院)接受手術(shù)治療的老年髖部骨折患者(≥65歲)308例(男94例,女214例,平均80.20±6.39歲),準(zhǔn)確記錄其基本個(gè)人信息、性別、年齡、骨折類型、術(shù)前中醫(yī)證型、入院合并癥、入院血紅蛋白水平、ASA評級、手術(shù)方式、麻醉方式、術(shù)中出血量、手術(shù)時(shí)間,通過電話或門診隨訪術(shù)后1年內(nèi)生存情況。對存活狀態(tài)的影響因素進(jìn)行單因素分析,采用χ2檢驗(yàn)(包括Fisher精確檢驗(yàn)、R×C列聯(lián)表χ2檢驗(yàn)),檢驗(yàn)水平為P0.05。把單因素分析證實(shí)有統(tǒng)計(jì)學(xué)差異的自變量帶入二分類Logistic回歸模型進(jìn)行多因素分析,P0.05為有統(tǒng)計(jì)學(xué)意義。結(jié)果:本研究共納入308例患者,其中男性94例(30.5%),女性214例(69.5%),平均年齡80.20±6.39歲,存活269例(87.3%),死亡39例(12.7%),住院期間死亡2例(0.6%),死亡患者平均年齡82.90±6.00歲,存活患者平均年齡79.81 ±6.35歲;骨折類型:股骨頸骨折137例(44.5%),股骨粗隆間骨折171例(55.50%);術(shù)前中醫(yī)證型:肝腎虧虛證,氣滯血瘀證218例(70.8%),氣血兩虛證72例(23.40%),痰瘀蘊(yùn)結(jié)證18例(5.8%);入院前合并癥:合并癥≤2種183例(59.4%),合并癥2種125例(40.6%);入院血紅蛋白水平:114.62± 17.64g/L;ASA評級:術(shù)前ASA評級為Ⅰ、Ⅱ級190例(61.7%),Ⅲ、Ⅳ級118例(38.3%);麻醉方式:椎管內(nèi)麻醉277例(89.9%),全麻31例(10.1%);手術(shù)方式:行人工關(guān)節(jié)置換術(shù)141例(45.8%),髓內(nèi)內(nèi)固定術(shù)115例(37.3%),髓外內(nèi)固定及其他固定形式52例(16.9%);術(shù)中出血量:手術(shù)中平均出血184.17±145.30ml;手術(shù)時(shí)間:平均93.08±31.86分鐘。單因素分析顯示年齡、術(shù)前中醫(yī)證型、合并癥、入院血紅蛋白水平、ASA評級是老年髖部骨折術(shù)后1年死亡的危險(xiǎn)因素(P0.05);二分類Logisti回歸模型進(jìn)行多因素分析顯示入院血紅蛋白水平(P=0.043,OR=0.625,CI:0.396～0.985)和ASA評級(P=0.021,OR=0.424,CI:0.205～0.877)是老年髖部骨折患者術(shù)后1年死亡的獨(dú)立危險(xiǎn)因素。結(jié)論:影響老年髖部骨折術(shù)后1年死亡率的危險(xiǎn)因素有多種,本研究顯示,年齡、術(shù)前中醫(yī)證型、合并癥、入院血紅蛋白水平、ASA評級是老年髖部骨折術(shù)后1年死亡的危險(xiǎn)因素,其中入院血紅蛋白水平和ASA評級是影響術(shù)后1年死亡率的獨(dú)立危險(xiǎn)因素。臨床醫(yī)師應(yīng)重視老年髖部骨折術(shù)前評估及圍手術(shù)期管理,配合中醫(yī)辨證論治,提高患者臨床療效以降低死亡率。
[Abstract]:Objective: to investigate the correlation between hemoglobin level and 1-year postoperative mortality in elderly patients with hip fracture. Methods: from January 2013 to December 2015, 308 elderly patients with hip fractures (94 males and 214 females) received surgical treatment in Guangdong Provincial Hospital of traditional Chinese Medicine (second affiliated Hospital of Guangzhou University of traditional Chinese Medicine) were retrospectively analyzed. The average age was 80.20 鹵6.39 years old. The basic personal information, sex, age, fracture type, preoperative TCM syndrome type, admission complication, admission hemoglobin level, ASA rating, operation mode, anesthetic method, intraoperative bleeding volume, operative time were recorded accurately. All patients were followed up by telephone or outpatient within 1 year after operation. Univariate analysis was carried out on the influencing factors of survival state. 蠂 2 test (including Fisher accurate test) was used to test R 脳 C table 蠂 2 test, the test level was P0.05. Univariate analysis confirmed that there was statistical difference between independent variables into the two-classification Logistic regression model for multivariate analysis (P0.05) for statistical significance. Results: a total of 308 patients were included in this study, of whom 94 were male (30.5) and 214 were female (69.559), with an average age of 80.20 鹵6.39 years old, 269 survival cases with 87.3 years of age, 39 cases with death of 12.7T, 2 cases with death during hospitalization, with an average age of 82.90 鹵6.00 years and an average age of 79.81 鹵6.35 years. Fracture type: 137 cases of femoral neck fracture and 171 cases of femoral intertrochanteric fracture. Qi stagnation and blood stasis syndrome, Qi stagnation and blood stasis syndrome in 218 cases, Qi and blood deficiency syndrome in 72 cases, phlegm and stasis accumulation syndrome in 18 cases, prehospital complications: complication 鈮，

本文編號：1877742