CAJ | 학술논문

目的：探讨髋关节置换术后发生主要不良心血管事件和深静脉血栓的危险因素。方法选择2009年1月至2013年10月南方医科大学附属花都医院诊断为股骨颈骨折初次行髋关节置换术的老年患者117例，其中男性49例，女性68例，年龄在60~92（69.4±8.1）岁。分析术后30 d内主要不良心血管事件、深静脉血栓的危险因素。结果所有患者采用美国麻醉师协会（ASA）评分Ⅰ级33例、Ⅱ级49例、Ⅲ级29例、Ⅳ级6例；麻醉方式局麻80例、全麻37例；术中输血情况1~2u 38例、>2u 42例。发生不良心血管事件8例（6.83%），深静脉血栓12例（10.26%），死亡5例（4.27%）。年龄（＞80岁）（OR=13.418，95%CI：1.201~149.916）、术前ASA评分Ⅲ、Ⅳ级（OR=18.782，95%CI：1.478~238.714）以及合并心力衰竭（OR=20.144，95%CI：1.094~370.942）患者术后发生心血管事件危险性增加。年龄（＞80岁）（OR=2.392，95%CI：1.179~4.856）术后发生深静脉血栓危险性增加。结论年龄（＞80岁）、术前ASA评分Ⅲ、Ⅳ级、合并心力衰竭患者髋关节置换术后发生30 d内主要不良心血管事件危险性增加，年龄（＞80岁）术后发生深静脉血栓危险性增加。
목적：탐토관관절치환술후발생주요불양심혈관사건화심정맥혈전적위험인소。방법선택2009년1월지2013년10월남방의과대학부속화도의원진단위고골경골절초차행관관절치환술적노년환자117례，기중남성49례，녀성68례，년령재60~92（69.4±8.1）세。분석술후30 d내주요불양심혈관사건、심정맥혈전적위험인소。결과소유환자채용미국마취사협회（ASA）평분Ⅰ급33례、Ⅱ급49례、Ⅲ급29례、Ⅳ급6례；마취방식국마80례、전마37례；술중수혈정황1~2u 38례、>2u 42례。발생불양심혈관사건8례（6.83%），심정맥혈전12례（10.26%），사망5례（4.27%）。년령（＞80세）（OR=13.418，95%CI：1.201~149.916）、술전ASA평분Ⅲ、Ⅳ급（OR=18.782，95%CI：1.478~238.714）이급합병심력쇠갈（OR=20.144，95%CI：1.094~370.942）환자술후발생심혈관사건위험성증가。년령（＞80세）（OR=2.392，95%CI：1.179~4.856）술후발생심정맥혈전위험성증가。결론년령（＞80세）、술전ASA평분Ⅲ、Ⅳ급、합병심력쇠갈환자관관절치환술후발생30 d내주요불양심혈관사건위험성증가，년령（＞80세）술후발생심정맥혈전위험성증가。
Objective To discuss the risk factors of major adverse cardiovascular events (MACE) and deep vein thrombosis (DVT) in patients undergoing total hip joint replacement (THR). Methods The elderly patients with femoral neck fracture and first-time THR (n=117, male 49, female 68, aged from 60 to 92 and average age=69.4±8.1) were chosen from Jan. 2009 to Oct. 2013. The risk factors of MACE and DVT were analyzed 30 d after THR. Results Among all patients, there were 33 with ASA grade I, 49 with ASA grade II, 29 with ASA grade III and 6 with ASA grade IV. There were 80 cases with local anesthesia and 37 with general anesthesia. There were 38 cases with transfusion volume from 1 u to 2 u and 42 with transfusion volume>2 u during THR. There were 8 cases (6.83%) with MACE, 12 (10.26%) with DVT and 5 (4.27%) died. The risk of MACE increased in patients with age>80 (OR=13.418, 95%CI:1.201~149.916), preoperative ASA grade III and ASA grade IV (OR=18.782, 95%CI:1.478~238.714) and complicating heart failure (OR=20.144, 95%CI:1.094~370.942), and risk of DVT increased in patients with age>80 (OR=2.392, 95%CI:1.179~4.856). Conclusion The risk of MACE increases in patients with age>80, preoperative ASA grade III, ASA grade IV and complicating heart failure 30 d after THR, and risk of DVT increases in patients with age>80 after THR.