摘要
目的探讨老年髋部骨折患者围术期发生脑血管意外的危险因素。方法收集接受手术治疗的168例老年髋部骨折患者临床资料,记录患者的一般情况(年龄、性别、BMI、烟酒史)、有无脑血管意外史、高血压病史、术中血压情况、麻醉方法、麻醉药物、术前颈动脉检查结果等,观察患者在围术期发生脑血管意外的情况,根据患者的病情进展分为脑血管意外组与无脑血管意外组,分析老年髋部骨折患者围术期发生脑血管意外的危险因素。结果168例老年髋部骨折患者中有25例围术期发生脑血管意外,143例未出现脑血管意外。单因素分析显示,2组患者中是否BMI≥24 kg/m2、有无脑血管意外史、有无高血压病史、术前有无颈动脉狭窄、是否全身麻醉、术中是否应用麻醉药物≥3种、术中血压是否≥140 mm Hg比较差异均有统计学意义(P均<0.05)。多因素Logistic回归显示,BMI≥24 kg/m2、有脑血管意外史、高血压病史、术前颈动脉狭窄、全身麻醉、术中应用麻醉药物≥3种、术中血压≥140 mm Hg是老年髋部骨折患者围术期发生脑血管意外的危险因素(P均<0.05)。结论BMI≥24 kg/m2、有脑血管意外史、有高血压病史、术前颈动脉狭窄、全身麻醉、术中应用麻醉药物≥3种、术中血压≥140 mm Hg是老年髋部骨折患者围术期发生脑血管意外的危险因素,临床医师在术前应充分了解患者的病史,并根据其实际病情选择合适的麻醉方案,合理控制患者的血压水平,并做好预防性治疗,以保障患者围术期安全,避免脑血管意外的发生。
Objective To explore the risk factors of cerebrovascular accident in elderly patients with hip fracture during the perioperative period.Methods Clinical data of 168 elderly patients with hip fracture undergoing surgery were retrospectively analyzed.All patients were divided into the cerebrovascular accident group and non-cerebrovascular accident group according to the disease progression.Baseline data(age,gender,BMI and history of smoking and alcohol drinking),history of cerebrovascular accident,history of hypertension,intraoperative blood pressure,anesthesia methods,anesthetic drugs,preoperative cervical artery examination results were compared between two groups.The main risk factors of the occurrence of perioperative cerebrovascular accident were analyzed.Results Among 168 elderly patients with hip fracture,25 cases experienced cerebrovascular accident during perioperative period.Univariate analysis showed that the BMI≥24 kg/m2,history of cerebrovascular accident,history of hypertension,intraoperative use of more than three anesthetic drugs,general anesthesia,intraoperative blood pressure elevation and preoperative carotid artery stenosis significantly differed between two groups(all P<0.05).Multivariate logistic regression analysis demonstrated that BMI≥24 kg/m2,history of cerebrovascular accident,history of hypertension,preoperative carotid artery stenosis,general anesthesia,intraoperative use of more than three anesthetic drugs and intraoperative blood pressure≥140 mm Hg were the main risk factors of cerebrovascular accident in perioperative period(all P<0.05).Conclusions BMI≥24 kg/m2,history of cerebrovascular accident,history of hypertension,preoperative carotid artery stenosis,general anesthesia,intraoperative administration of more than three anesthetic drugs and intraoperative blood pressure≥140 mm Hg are the risk factors leading to cerebrovascular accidents in elderly patients with hip fractures during perioperative period.Therefore,clinicians should fully understand the medical history,choose an appropriate anesthesia plan according to the actual conditions,reasonably control the blood pressure and deliver preventive treatment to ensure the patients’safety during the perioperative period and avoid the risk of cerebrovascular accident.
作者
马晋
孙春汉
黄建华
Ma Jin;Sun Chunhan(Department of Orthopaedics,Huang Jianhua.Huizhou First People’s Hospital,Huizhou 516000,China)
出处
《新医学》
2020年第9期714-717,共4页
Journal of New Medicine
关键词
髋部骨折
老年患者
脑血管意外
影响因素
Hip fracture
Elderly patient
Cerebrovascular accident
Influencing factor
