高龄患者全髋关节置换术后死亡危险因素分析与护理对策

摘要

目的：分析高龄患者全髋关节置换术后死亡的危险因素，并提出相应护理对策。方法选取2010年1月-2012年10月在我院接受全髋关节置换，并入住骨科重症监护病区的80岁以上股骨颈骨折患者117例。记录患者的年龄、性别、体质量、合并内科疾病、手术时间、术中出血量、住院时间、术后并发症和手术预后。按手术预后将患者分为康复组107例和死亡组10例，将单因素分析有统计学意义的变量引入 Logistic 回归模型进行多因素分析，根据分析结果提出相应的护理对策。结果单因素分析表明：男性、心血管疾病、呼吸疾病、脑血管疾病、术中出血量、住院时间、术后肺部感染、合并内科疾病的种类≥2种8个因素两组间比较差异有统计学意义，多因素分析显示其中呼吸疾病、术后肺部感染、合并内科疾病的种类≥3是术后死亡的独立危险因素（OR 值分别为3.280、10.223、6.828）。结论对于高龄行全髋关节置换术患者，术前合并呼吸疾病、内科疾病种类、术后肺部感染与术后死亡关系密切，提示术前需进行充分的病情评估及相关准备，术后严密观察和精心护理，以保证手术的安全性。%Objective To analyze risk factors of death of elderly patients after total hip replacement (THR) and to provide nursing countermeasures. Methods Clinical data of 117 elderly patients (aged over 80) with femoral neck fractures who treated by THR from January 2010 to October 2012 and stayed in orthopedic ICU were collected in this study. Age, gender, weight, preoperative comorbidities, operation time, intraoperative blood loss, hospital stay, complications and prognosis were recorded. Patients were divided into rehabilitation group and in-hospital death group according to the prognosis. The potential risk factors of in-hospital death were analyzed by multiple logistic regression model after they were identified by univariate model, and then corresponding nursing countermeasures were put forward. Results Univariate factor analysis showed that in-hospital death was associated with eight factors including male, cardiovascular diseases, respiratory diseases, cerebrovascular diseases, intraoperative blood loss, postoperative hospital stay, postoperative pulmonary infection and more than two preoperative comorbidities. Respiratory diseases, postoperative pulmonary infection and more than three comorbidities were independent risk factors for in-hospital death. Conclusion For elderly patients with femoral neck fracture, preoperative comorbidities has close relations to in-hospital death after THR, indicating that sufficient disease evaluation and relative preparation before surgery, as well as postoperative observation and intensive nursing should be emphasized to ensure surgical safety.