CAJ | 학술논문

目的：研究老年髋部骨折围术期输血与临床预后的关系。方法回顾性地分析解放军总医院2010年～2012年期间连续性收治的所有老年髋部骨折患者，将最低血红蛋白（Hb）＞80g/L的患者按照围术期是否输血分为输血组及未输血组。比较两组患者术后并发症及术后1个月、12个月死亡率差异，分析围术期输血与术后死亡的相关性。结果共纳入931例患者，706（75.8%）例患者接受输血治疗，输血组最低Hb浓度为（105.2±15.4）g/L，未输血组最低Hb浓度为（110.5±16.5）g/L。输血组术后心脑血管并发症发生率明显高于未输血组（7.5%vs 3.6%，P＝0.037），两组患者术后感染性并发症及死亡率差异均无统计学意义（均P＞0.05）。多因素分析结果显示高龄及低Hb浓度为术后死亡的独立危险因素，而输血并非影响死亡的独立因素。结论高龄和低Hb浓度是老年髋部骨折患者术后死亡的独立危险因素，但围术期输血并不能明显改善患者预后。
목적：연구노년관부골절위술기수혈여림상예후적관계。방법회고성지분석해방군총의원2010년～2012년기간련속성수치적소유노년관부골절환자，장최저혈홍단백（Hb）＞80g/L적환자안조위술기시부수혈분위수혈조급미수혈조。비교량조환자술후병발증급술후1개월、12개월사망솔차이，분석위술기수혈여술후사망적상관성。결과공납입931례환자，706（75.8%）례환자접수수혈치료，수혈조최저Hb농도위（105.2±15.4）g/L，미수혈조최저Hb농도위（110.5±16.5）g/L。수혈조술후심뇌혈관병발증발생솔명현고우미수혈조（7.5%vs 3.6%，P＝0.037），량조환자술후감염성병발증급사망솔차이균무통계학의의（균P＞0.05）。다인소분석결과현시고령급저Hb농도위술후사망적독립위험인소，이수혈병비영향사망적독립인소。결론고령화저Hb농도시노년관부골절환자술후사망적독립위험인소，단위술기수혈병불능명현개선환자예후。
ObjectiveTo investigate the relationship ofperioperative blood transfusionwith clinicalprognosis in the elderlyhip fracturepatients.Methods Consecutiveelderlypatients(over 60 years old) withhip fractureadmitted in ourdepartment during the yearsof2010 to 2012 were subjected andretrospectivelyanalyzed.All patients with the lowest hemoglobin(Hb)concentration>80g/L weredivided into2 groups, receiving red blood cell transfusion(transfusion group)or not (control group). The incidence of postoperative complications and1-monthor12-monthmortality were comparedbetween the 2 groups. The correlation of perioperative blood transfusionwith postoperativedeath was analyzed.ResultsA total of 931 patients wererecruited in this study. There were 706 (75.8%) patients receiving red blood cell transfusion,from them the mean lowestHbin concentrationwas (105.2±15.4)g/L.Andamong the patientswithout blood transfusionthelowest Hbconcentrationwas(110.5±16.5)g/L. The incidence of postoperative cardiovascular complications was obviously higherin the transfusion group thanthanin control group (7.5%vs 3.6%,P=0.037), but there was no significant difference in postoperative infectious complications or mortality between the 2 groups (P>0.05).Multivariate analysis showed thatseniorage and lowHb concentration were independent risk factors for postoperativedeath,butblood transfusion was not.Conclusion Senior age and lowHb concentrationare independent risk factors for elderly patients suffering hip fractures,butperioperative blood transfusioncan not improve the outcomes of these patients.