CAJ | 학술논문

目的分析高龄骨科手术患者围术期预后的影响因素.方法选择2010年2月至2012年8月104例高龄下肢骨科择期手术患者.患者分别施行全髋关节置换术(11例,10.6％)、单侧股骨头置换术(24例,23.1％)、单侧膝关节置换术(8例,7.7％)和下肢骨折切开复位内固定术(61例,58.7％).以术后住院时间为因变量;以患者年龄、性别、手术方式和麻醉方式、术前生理学和手术严重程度评分系统(POSSUM)评分、术前总胆固醇和术前血糖为自变量;并用多因素线性回归分析模型评价各影响因素的作用大小.结果本组患者围术期无死亡,19例患者(18.3％)有术后并发症.患者术后有并发症组术前POSSUM评分和住院时间与无并发症组比较差异均有统计学意义[(27±4)分比(22±5)分,(27±6)d比(18±7)d](均P＜0.05).高龄骨科手术患者围术期预后影响因素包括术后并发症和术前POSSUM评分.结论在高龄骨科患者手术的临床监测指标中,患者的术前POSSUM生理评分和术后并发症与预后密切相关.术前应对这类患者进行全面评估,围术期加强管理,减少术后并发症发生,使患者可以安全、平稳地度过围术期.
목적 분석고령골과수술환자위술기예후적영향인소.방법 선택2010년2월지2012년8월104례고령하지골과택기수술환자.환자분별시행전관관절치환술(11례,10.6％)、단측고골두치환술(24례,23.1％)、단측슬관절치환술(8례,7.7％)화하지골절절개복위내고정술(61례,58.7％).이술후주원시간위인변량;이환자년령、성별、수술방식화마취방식、술전생이학화수술엄중정도평분계통(POSSUM)평분、술전총담고순화술전혈당위자변량;병용다인소선성회귀분석모형평개각영향인소적작용대소.결과 본조환자위술기무사망,19례환자(18.3％)유술후병발증.환자술후유병발증조술전POSSUM평분화주원시간여무병발증조비교차이균유통계학의의[(27±4)분비(22±5)분,(27±6)d비(18±7)d](균P＜0.05).고령골과수술환자위술기예후영향인소포괄술후병발증화술전POSSUM평분.결론 재고령골과환자수술적림상감측지표중,환자적술전POSSUM생리평분화술후병발증여예후밀절상관.술전응대저류환자진행전면평고,위술기가강관리,감소술후병발증발생,사환자가이안전、평은지도과위술기.
Objective To analyze the correlation between the general perioperative characteristics and the prognosis after orthopaedic surgery in elderly patients.Methods Totally 104 elderly patients scheduled for an orthopaedic surgery were included in the study from Feb.2010 to Aug.2012,including 69 cases from Beijing Anzhen Hospital and 35 cases from the People's Liberation Army 305 Hospital.All patients suffered from total hip joint replacement(11 cases,10.6％),unilateral artificial femoral head replacement(24 cases,23.1％),unilateral knee joint arthroplasty(8 cases,7.7％),open reduction and internal fixation for lower limb fracture(61 cases,58.7％).Duration of hospital stay was recorded for determination of perioperative outcomes.The component of cases included age,gender,method of surgery and anesthesia,POSSUM physiologic score,total cholesterol concentration and blood glucose concentration before operation.Results The mortality was 0 in all patients.19 cases (18.3％) had complications after operation.Compared with non-complication group,duration of hospital stay and POSSUM physiologic score before operation were increased significantly in complication group [(27 ± 4)scores vs (22 ± 5) scores,(27 ± 6) d vs (18 ± 7) d] (P ＜ 0.05).Multivariate liner regress analysis showed that duration of hospital stay after orthopaedic surgery in elderly patients was related with the POSSUM preoperative and postoperative complications.Conclusions Preoperative and postoperative complications are predominant factors of perioperative outcomes after orthopaedic surgery in elderly patients.Full preoperative assessment,careful operating during perioperative stage and good symptomatic treatment are very important during perioperative period.