Objective To investigate the associations between levels of perioperative biochemical markers of the liver,kidney,lung and heart and death within 3 months postoperatively in the senile patients with femoral intertrochanteric fracture.Methods A retrospective study was conducted on the 153 senile patients with femoral intertrochanteric fracture who had been treated at Nanfang Hospital from January 2010 to January 2012.They were 71 men and 82 women,with an average age of 83.1 years.There were 70 stable and 83 unstable fractures.At preoperation (within 24 h after admission),and 24 h,25 to 48 h and 72 h postoperation,all the patients had blood examinations of biochemical markers of the liver [alanine aminotransaminase (ALT)],kidney (creatinine and urea nitrogen),lung (PaO2) and heart [brain natriuretic peptide (BNP)].The levels of biochemical markers at all time points and clinical data were compared between the living patients and those who died within 3 months postoperatively.Univariate and multivariate logistic regression analyses were conducted to estimate the independent risk factors for mortality within 3 months postoperatively.Results Of the 153 patients,32 (20.9％) died within 3 months postoperatively,including 10 men and 22 women.In the dead and surviving patients,there were respectively 25 and 17 cases who were rated as level Ⅲ or Ⅳ by ASA (American Society of Anesthesiologists).The levels of ALT,creatinine,urea nitrogen,and BNP increased to different extents while the level of PaO2 decreased postoperatively in both the dead and surviving patients.The differences between the dead and surviving patients were statistically significant (P ＜ 0.05).Multivariate logistic regression analysis showed poor preoperative physical condition (ASA level Ⅲ or Ⅳ),increased creatinine level at 25 to 48 h postoperation,decreased PaO2 at 72 h postoperation,and increased BNP level at 24 h postoperation were independent risk factors for early mortality in senile patients with femoral intertrochanteric fracture.Conclusions Femoral intertrochanteric fracture in senile patients may lead to changes in the liver,kidney,lung and heart.Prompt and dynamic monitoring of the levels of PaO2,creatinine and BNP may provide timely prediction of the poor prognosis.%目的 探讨老年股骨转子间骨折患者围手术期肝脏、肾脏、肺部及心脏的生化指标与患者术后3个月内死亡的关系.方法 回顾性分析2010年1月至2012年1月收治的153例股骨转子间骨折患者资料,男71例,女82例;平均年龄为83.1岁;稳定型骨折70例,不稳定型骨折83例.术前(入院后24 h内)、术后24 h内、术后25～48 h、术后72 h检测患者肝脏(丙氨酸转氨酶)、肾脏(肌酐、尿素氮)、肺部(血氧分压)和心脏(B型钠尿肽)的血清学指标.比较死亡及存活患者术前、术中资料及不同时间点肝脏、肾脏、肺部及心脏等生化指标.先行单因素方差分析,再采用多因素logistic回归分析确定术后早期死亡的独立危险因素.结果 153例患者中32例(20.9％)于术后3个月内死亡,其中男10例,女22例.死亡和存活患者中分别有25、17例患者术前美国麻醉医师协会(ASA)分级为Ⅲ、Ⅳ级.死亡及存活患者术后丙氨酸转氨酶、肌酐、尿素氮、B型钠尿肽均有不同程度升高,而血氧分压术后开始下降,死亡患者与存活患者之间比较差异均有统计学意义(P＜0.05).多因素logistic回归分析结果显示:术前身体状况差(ASA分级为Ⅲ、Ⅳ级)、术后25～48 h肌酐升高、术后72 h血氧分压降低及术后24 h内B型钠尿肽升高是老年股骨转子间骨折患者术后3个月死亡的独立危险因素. 结论 老年股骨转子间骨折可导致肝脏、肾脏、肺部及心脏发生一系列改变,及时、动态监测血氧分压、肌酐、B型钠尿肽水平可对不良预后作出早期评估.
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