| 老年髋部骨折患者术后1年死亡率与术前血清指标及术后营养指导的相关性分析 |
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投稿时间：2020-05-17
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| 作者 | Author | 单位 | Address | E-Mail |
| 周根秀 |
ZHOU Gen-xiu |
广州市第一人民医院创伤外科, 广东 广州 510180 |
Department of Trauma Surgery, the First People's Hospital of Guangzhou, Guangzhou 510180, Guangdong, China |
psbyzgxly@163.com |
| 谢青梅 |
XIE Qing-mei |
广州市第一人民医院创伤外科, 广东 广州 510180 |
Department of Trauma Surgery, the First People's Hospital of Guangzhou, Guangzhou 510180, Guangdong, China |
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| 张成娟 |
ZHANG Cheng-juan |
广州市第一人民医院创伤外科, 广东 广州 510180 |
Department of Trauma Surgery, the First People's Hospital of Guangzhou, Guangzhou 510180, Guangdong, China |
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| 杨娜 |
YANG Na |
广州市第一人民医院创伤外科, 广东 广州 510180 |
Department of Trauma Surgery, the First People's Hospital of Guangzhou, Guangzhou 510180, Guangdong, China |
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| 陈军平 |
CHEN Jun-ping |
遵义医科大学第五附属珠海医院骨科, 广东 珠海 519100 |
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| 秦春桃 |
QIN Chun-tao |
广州市第一人民医院创伤外科, 广东 广州 510180 |
Department of Trauma Surgery, the First People's Hospital of Guangzhou, Guangzhou 510180, Guangdong, China |
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| 期刊信息：《中国骨伤》2021年，第34卷，第7期，第605-611页 |
| DOI：10.12200/j.issn.1003-0034.2021.07.004 |
| 基金项目: |
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中文摘要:
目的：分析老年髋部骨折患者术前血清营养学指标及术后营养指导对术后1年死亡率的影响。
方法：将2015年1月至2017年12月行手术治疗的396例老年髋部骨折患者纳入研究，其中女267例，男129例，年龄68~80（75.48±2.62）岁；病程2~10（6.12±1.35） d；所有患者术后进行为期1年随访，根据患者是否死亡，将其分为死亡组及存活组，对两组患者的一般资料、手术相关信息及相关营养学指标进行比较，采用多因素Logistic回归模型对影响患者1年死亡率的因素进行分析。
结果：随访过程中有4例患者失联，按脱落处理，其中67例患者死亡，325例患者存活，死亡组患者年龄、男性患者、合并3种以上基础疾病、美国麻醉医师协会分级Ⅲ-Ⅳ级及合并术后并发症的患者明显高于存活组（均P<0.05）；两组患者的体质量指数（body mass index，BMI），吸烟人数及骨折类型，手术类型等因素间无明显差异（均P>0.05）；死亡组患者的血清白蛋白（albumin，ALB），前白蛋白（prealbumin，PA），淋巴细胞（lymphocyte，LYM），淋巴细胞百分比（LYM%），血红蛋白（hemoglobin，HB），转铁蛋白（transferrin，TRF），总蛋白（total protein，TP）水平显著低于存活组（t=5.884，5.826，2.020，5.665，4.726，4.935，2.862；均P<0.05），且死亡组患者接受营养指导的患者明显少于存活组（χ2=12.597，P=0.000），而两组患者白细胞（white blood cell，WBC），红细胞（red blood cell，RBC）等指标差异无统计学意义（均P>0.05）。多因素Logistic回归分析显示高龄、男性及未接受营养指导是影响老年患者髋部骨折术后1年死亡率的独立危险因素（OR=01.309，43.548，6.032；均P<0.05）；高血清ALB、PA、HB、LYM%水平及合并2种以下基础疾病是其保护因素（OR=00.958，0.913，0.985，0.954，0.832；均P<0.05）。
结论：高龄、男性及合并多种基础疾病是老年髋部骨折患者术后1年死亡率的独立危险因素，而患者术前较高营养水平及术后常规接受营养指导是其保护因素。 |
| 【关键词】髋骨折 老年人 死亡率 营养状况 |
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| Correlation analysis of one-year postoperative mortality,preoperative serum indexes and postoperative nutrition guidance in elderly hip fracture patients |
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ABSTRACT
Objective: To analyze the influence of preoperative serum nutritional indexes and postoperative nutritional guidance on 1-year mortality in elderly patients with hip fracture.
Methods: From January 2015 to December 2017,396 elderly patients with hip fracture were included in the study,including 267 females and 129 males,aged 68 to 80(75.48±2.62) years;the course of disease was 2 to 10(6.12±1.35) days;all patients were followed up for 1 year,and were divided into death group and survival group according to whether the patients died or not. Multivariate logistic regression model was used to analyze the influencing factors of 1-year mortality.
Results: During the follow-up,4 patients lost contact and were treated as shedding,among which 67 patients died and 325 patients survived. The age,male patients,patients with more than three basic diseases,American Society of Anesthesiologists grade Ⅲ-Ⅳ and patients with postoperative complications in the death group were significantly higher than those in the survival group (all P<0.05). There was no significant difference in body mass index(BMI),number of smokers,fracture type and operation type (all P>0.05). The serum albumin (ALB),prealbumin (PA),lymphocyte (LYM),lymphocyte percentage(LYM%),hemoglobin(HB),transferrin(TRF),total protein(TP) in the death group were significantly lower than those in the survival group(t=5.884,5.826,2.020,5.665,4.726,4.935,2.862;all P<0.05). The number of patients receiving nutritional guidance in the death group was significantly less than that in the survival group(χ2=12.597,P=0.000). There were no significant difference on white blood cell(WBC) and red blood cell(RBC) between two groups. Multivariate logistic regression analysis showed that old age,male and not receiving significant nutritional guidance were independent risk factors for 1-year mortality of elderly patients with hip fracture(OR=01.309,43.548,6.032;all P<0.05);high serum ALB,PA,HB,LYM% levels and combined with two or less basic diseases were protective factors(OR=00.958,0. 913,0.985,0.954,0.832;all P<0.05).
Conclusion: Advanced age,male and multiple underlying diseases were independent risk factors for 1-year mortality in elderly patients with hip fracture,while higher preoperative nutritional level and routine nutritional guidance were protective factors. |
| KEY WORDS Hip fractures Aged Mortality Nutritional status |
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| 中文格式: | 周根秀,谢青梅,张成娟,杨娜,陈军平,秦春桃.老年髋部骨折患者术后1年死亡率与术前血清指标及术后营养指导的相关性分析[J].中国骨伤,2021,34(7):605~611 |
| 英文格式: | ZHOU Gen-xiu,XIE Qing-mei,ZHANG Cheng-juan,YANG Na,CHEN Jun-ping,QIN Chun-tao.Correlation analysis of one-year postoperative mortality,preoperative serum indexes and postoperative nutrition guidance in elderly hip fracture patients[J].zhongguo gu shang / China J Orthop Trauma ,2021,34(7):605~611 |
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