糖尿病对老年髋部骨折患者围术期并发症的影响

摘要

目的 探讨糖尿病对老年髋部骨折患者围术期并发症、手术拆线时间和住院时间的影响. 方法 选取我院2009年7月至201 0年1 2月期间出院的、年龄≥60岁、且因低能量损伤导致的髋部骨折患者601例,比较糖尿病患者与对照组患者围术期并发症发生率与住院日的差异. 结果 共纳入分析601例,男性188例,女性413例；其中合并糖尿病患者(糖尿病组)157例,未合并糖尿病患者(对照组)444例.两组手术切口感染率、拆线时间比较,差异均无统计学意义(P＞0.05)；围术期谵妄、肺部感染、下肢静脉血栓发生率的差异无统计学意义(P＞0.05)；但心脏疾病(8.3％比2.9％,x2=0.803,P=0.005)、泌尿系感染(12.7％比8.3％,x2=19.968,P=0.001)、胃肠道疾病(15.3％比6.8％,x2=8.317,P=0.004)等并发症的发生率较高,差异均有统计学意义；术前准备时间(7.8d比6.5d,t=2.310,P=0.021)及住院时间(16.6d比14.0d,t=3.739,P＜0.001)更长.结论 糖尿病增加髋部骨折患者围术期心脏疾病、胃肠道疾病、泌尿系感染等并发症的风险,且手术准备时间和住院时间较长.%Objective To evaluate the impact of diabetes on the perioperative complications in elderly hip fracture patients.Methods A total of 601 patients (aged ≥60 years,188 male and 413female) with hip fracture caused by low energy damage in Jishuitan hospital from July 2009 to Dec 2010 were included.The patients were divided into the diabetic group (n=157) and the non-diabetic group (n=444).The complications during hospital stay were compared between the two groups.The average number of preoperative admission days and length of hospital stay were analyzed.Results There were no differences in the rate of incision infection and wound healing time between groups (P＞0.05).During the perioperative period,no differences in incidence of delirium,pneumonia and phlebothrombosis of lower extremity were found between groups (P＞0.05).However,the diabetic group was more likely to develop cardiac complications (8.9 ％ vs.2.9 ％,x2 =0.803,P =0.005),urinary tract infections (12.7％ vs.3.2％,x2=19.968,P＜0.001) and gastrointestinal complications(15.3％ vs.6.8％,x2 =8.317,P =0.004) as compared with non-diabetes.The preoperative preparation time,length of hospital stay were both longer in the diabetic group than non diabetic group [(7.8 days vs.6.5 days,P=0.021),(16.6 days vs.14.0 days,P＜0.001)].Conclusions The elderly hip fracture patients with diabetes are at a higher risk of the perioperative cardiac complications,gastrointestinal diseases and urinary tract infections.In addition,elderly hip fracture patients with diabetes have longer preoperative preparation time and hospital stay.