摘要
目的:探讨老年髋部骨折患者的院内死亡原因及死亡风险评估方法。方法:回顾性分析2015年5月至2017年12月期间北京积水潭医院创伤骨科收治的1878例老年髋部骨折患者资料。男543例,女1335例,男女比为1∶2.5;平均年龄为79.6岁(65~105岁);骨折类型:股骨颈骨折988例(52.6%),股骨转子间骨折850例(45.3%),股骨转子下骨折40例(2.1%)。手术治疗1781例,占94.8%(1781/1878)。记录患者的院内病死率,分析引起院内死亡的原因;采用生理功能及手术应激评分(E-PASS)和诺丁汉髋部骨折评分(NHFS)评估院内死亡患者,小范围验证这两种评估工具的准确性。结果:本组共13例患者院内死亡,院内病死率为0.69%(13/1878)。直接死亡原因:肺部感染7例,急性心肌梗死2例,急性糜烂出血性胃炎2例,急性呼吸窘迫综合征1例,可疑急性肺栓塞1例。13例死亡患者应用E-PASS评估的病死率为5.3%±2.8%,而应用NHFS评估的病死率为9.3%±4.0%,差异有统计学意义(t=2.596,P=0.023)。结论:老年髋部骨折患者围手术期肺部感染的风险较高,在治疗过程中需警惕并早期预防;应注意监测心血管事件、血糖,并预防应激性溃疡。推荐采用NHFS评估老年髋部骨折患者的院内死亡风险。
Objective To analyze the causes and risks of in-hospital death in geriatric patients with hip fracture.Methods Retrospectively analyzed were the data of 1,878 elderly patients with hip fracture who had been admitted to Department of Orthopaedics and Traumatology,Beijing Jishuitan Hospital from May 2015 to December 2017.There were 543 males and 1,335 females,with a male-to-female ratio of 1∶2.5 and a mean age of 79.6 years(from 65 to 105 years).There were 988(52.6%)femoral neck fractures,850(45.3%)intertrochanteric fractures,and 40(2.1%)femoral subtrochanteric fractures.94.8%of the patients(1,781/1,878)received surgery.Cases of in-hospital death were recorded and their causes analyzed.The Estimation of Physiologic Ability and Surgical Stress(E-PASS)and the Nottingham Hip Fracture Score(NHFS)were used to assess the in-hospital deaths.The accuracy of these 2 assessment tools was validated on a small scale.Results Thirteen in-hospital deaths were recorded,giving an in-hospital mortality of 0.69%(13/1,878).The direct causes of death were pulmonary infection in 7 cases,acute myocardial infarction in 2 cases,acute erosive hemorrhagic gastritis in 2 cases,acute respiratory distress syndrome in one,and suspected acute pulmonary embolism in one.Thirteen patients died,yielding a rate of in-hospital death of 5.3%±2.8%by E-PASS and that of 9.3%±4.0%by NHFS which were statistically different(t=2.596,P=0.023).Conclusions As geriatric patients with hip fracture are at a high risk of perioperative pulmonary infection,vigilance and early prevention are required during treatment.Care should be taken to monitor cardiovascular events and blood glucose,and stress ulcers should be prevented.The NHFS is recommended to assess the risks of in-hospital death in geriatric patients with hip fracture.
作者
李宁
李新萍
杨明辉
Li Ning;Li Xinping;Yang Minghui(Department of Orthopaedics and Traumatology,Beijing Jishuitan Hospital,Beijing 100035,China;Department of Geriatrics,Beijing Jishuitan Hospital,Beijing 100035,China)
出处
《中华创伤骨科杂志》
CAS
CSCD
北大核心
2022年第9期773-778,共6页
Chinese Journal of Orthopaedic Trauma
基金
北京市医院管理中心"青苗"计划 (QML20190402)
北京积水潭医院"学科骨干"培养计划 (XKGG201808)。
关键词
髋骨折
死亡原因
住院
老年人
风险评估
Hip fractures
Cause of death
Hospitalization
Aged
Risk assessment
