入院时低基础代谢率与老年髋部骨折患者死亡率的关系

摘要

BACKGROUND: Basal metabolic rate (BMR) is an important indicator of human energy metabolism, and low BMR leads to the dysfunction of liver and kidney. Low BMR is usually found in patients with hip fractures, but there is a lack of study on the relationship between mortality of hip fracture and low BMR. OBJECTIVE: To investigate the effect of low BMR on the 1-year mortality in older adults with hip fractures. METHODS: Totally 507 patients with hip fractures aged more than 60 years from January 2014 to March 2016 were included in this retrospective study. Age, sex, surgery or not, surgical pathway, duration from injury to surgery, hospitalized pulmonary infection, number and kind of comorbidities, and 1-year mortality were recorded. BMR on admission was recorded, and multiple Logistic regression analysis was applied. RESULTS AND CONCLUSION: All patients were followed up for 13-15 months, and the 1-year mortality was 13.41% (68/507). The mortality in the low BMR group was significantly higher than that in the non-low BMR group (P ＜ 0.05). Logistic regression analysis showed that older age, conventional treatment, number of combined medical diseases, hospitalized pulmonary infection, and low BMR are risk factors for 1-year mortality in older adults with hip fracture. These results imply that low BMR is strongly associated with 1-year mortality in older adults with hip fracture. BMR can reflect the nutritional status, neuroendocrine, cellular and energy metabolism. Thereafter, for older adults with hip fractures and low BMI, nutrition therapy, re-warming, and endocrine therapy may help reduce the trauma-induced mortality.%背景:基础代谢率是人体能量代谢的重要指标,低基础代谢率反映维持机体稳态的重要器官如肝、肾功能低下.试验发现入院时低基础代谢率在髋部骨折患者中是较常见的,而目前尚无髋部骨折死亡率与低基础代谢率的关系的研究.目的:探讨老年髋部骨折患者入院时低基础代谢率对1年死亡率的影响.方法:回顾性分析2014年1月至2016年3月共507例60岁以上髋部骨折患者资料,记录年龄、性别、是否手术、手术方式、受伤至手术时间、住院期间是否发生肺部感染、内科疾病并发症的种类及数目,计算入院时的基础代谢率,随访并统计患者的 1 年死亡率并将以上常见危险因素与入院时基础代谢率值代入多因素Logistic回归分析.结果与结论:①死亡率:患者507例随访时间为13-15个月,1年内死亡率为13.41%(68/507).低基础代谢率组死亡率高于非低基础代谢率组(P ＜ 0.05);②危险因素分析:Logistic回归分析结果显示入院时高龄、非手术治疗、合并内科疾病数量、住院期间发生肺部感染、低基础代谢率为老年髋部骨折患者 1 年死亡率的危险因素;③结果说明,入院时低基础代谢率为老年髋部骨折患者 1 年死亡率的危险因素,基础代谢率能反映出患者营养状况、神经-内分泌、细胞及能量代谢等方面的状况.对于低基础代谢率值的老年髋部骨折患者进行加强营养、体温复苏、及内分泌方面的治疗可能有助于降低创伤导致的死亡率.