美国麻醉师学会分类对老年髋部骨折患者预后的预测价值

中华创伤杂志 Pub Date : 2020-01-15 DOI:10.3760/CMA.J.ISSN.1001-8050.2020.01.011

Xiaowei Wang, T. Sun, Jianzheng Zhang, Jian-wen Zhao

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Data compared among the groups included gender, age, comorbidities, fracture type, anesthesia methods, surgical methods, length of hospital stay, complications, and 30-day and 1-year mortality rates. Multiple Logistic analysis was conducted to seek independent risk factors for 1-year mortality. \n \n \nResults \nThere were no significant difference among the four groups with regards to gender, fracture type, surgical methods (P>0.05 ). With the improvement of ASA classification, the age of patients increased gradually, the length of hospital stay increased, and the rate of nerve block anesthesia increased ( allP<0.01). Incidence of complications of ASA grade IV patients was the highest [59%(13/22)], followed by 31.4%(122/389) of ASA grade Ⅲ patients, 17.6%(67/380) of ASA grade II patients, 4%(1/23) of ASA grade I patients (all P<0.01). The 30-day and 9-0day mortality of ASA grade IV patients were 32% (7/22), 64% (14/22), ASA grade III patients were 4.6% (18/389), 17.0% (66/389), ASA grade II patients were 3.4% (13/380), 12.1% (46/380), and ASA grade I patients were 0 and 4% (1/23), respectively. The differences between these groups were significantly different ( allP<0.01). Univariate analysis showed that male, advanced age, coronary heart disease, pulmonary infections, chronic obstructive pulmonary diseases (COPD), renal insufficiency, ASA classification, anesthesia methods, and length of hospital stay were related to postoperative 1-year death (P<0.05 or 0.01). A total of 127 patients (15.6%) died within 1 year after operation. 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引用次数: 2

摘要

目的探讨美国麻醉师学会（ASA）分级对老年髋部骨折患者预后的预测作用。方法采用回顾性病例对照研究方法，对2012年1月至2015年12月在解放军总医院第七医学中心住院的814例老年髋部骨折患者的临床资料进行分析。共有272名男性和542名女性，年龄范围为60-99岁[（80.0±8.0）岁]。根据ASA分类，患者分为四组：ASA I级23例（2.8%），ASA II级380例（46.7%），ASA III级389例（47.8%）和ASA IV级22例（2.7%），麻醉方法、手术方法、住院时间、并发症以及30天和1年死亡率。进行多元Logistic分析以寻找1年死亡率的独立危险因素。结果四组患者在性别、骨折类型、手术方式等方面差异无统计学意义（P>0.05）。随着ASA分级的提高，患者年龄逐渐增加，住院时间增加，神经阻滞麻醉率增加（allP<0.01）。ASA IV级患者并发症发生率最高[59%（13/22）]，其次是ASA III级患者的31.4%（122/389）、ASA II级患者的17.6%（67/380），ASA I级患者的30天和9-0天死亡率分别为32%（7/22）、64%（14/22）、4.6%（18/389）、17.0%（66/389）、3.4%（13/380）、12.1%（46/380）和4%（1/23）。单因素分析显示，男性、高龄、冠心病、肺部感染、慢性阻塞性肺病、肾功能不全、ASA分级、麻醉方法、，术后1年内死亡127例（15.6%）。多因素Logistic回归分析显示年龄（OR=1.037，95%CI 1.007-1.068）、ASA分级（ASA II级：OR=1.851，95%CI 1.238-14.386；ASA III级：OR=2.092，95%CI 1.266-16.482；ASA IV级：OR=15.368，95%CI 1.626-145。283）、住院时间（OR=1.038，95%CI 1.015-1.061）是1年死亡率的独立危险因素。结论老年髋部骨折治疗效果较差。ASA分级与并发症发生率、30天死亡率和1年死亡率密切相关。高龄、ASAⅡ、Ⅲ、Ⅳ级、住院时间是髋部骨折预后不良的独立危险因素。ASA分类可作为筛查工具，尽早对高危人群进行干预。关键词：髋部骨折；预后；老化

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Predictive value of American Society of Anesthesiologists classification on prognosis of elderly patients with hip fracture

Objective To explore the predictive effect of American Society of Anesthesiologists (ASA) classification on prognosis of elderly patients with hip fracture. Methods A retrospective case-control study was conducted to analyze the clinical data of 814 elderly patients with hip fracture admitted to the 7th Medical Center of the General Hospital of the PLA from January 2012 to December 2015. There were 272 males and 542 females, with the age range of 60-99 years [(80.0±8.0)years]. According to ASA classification, the patients were divided into four groups: 23 cases (2.8%) of ASA grade I, 380 cases (46.7%) of ASA grade II, 389 cases (47.8%) of ASA grade III and 22 cases (2.7%) of ASA grade IV. Data compared among the groups included gender, age, comorbidities, fracture type, anesthesia methods, surgical methods, length of hospital stay, complications, and 30-day and 1-year mortality rates. Multiple Logistic analysis was conducted to seek independent risk factors for 1-year mortality. Results There were no significant difference among the four groups with regards to gender, fracture type, surgical methods (P>0.05 ). With the improvement of ASA classification, the age of patients increased gradually, the length of hospital stay increased, and the rate of nerve block anesthesia increased ( allP<0.01). Incidence of complications of ASA grade IV patients was the highest [59%(13/22)], followed by 31.4%(122/389) of ASA grade Ⅲ patients, 17.6%(67/380) of ASA grade II patients, 4%(1/23) of ASA grade I patients (all P<0.01). The 30-day and 9-0day mortality of ASA grade IV patients were 32% (7/22), 64% (14/22), ASA grade III patients were 4.6% (18/389), 17.0% (66/389), ASA grade II patients were 3.4% (13/380), 12.1% (46/380), and ASA grade I patients were 0 and 4% (1/23), respectively. The differences between these groups were significantly different ( allP<0.01). Univariate analysis showed that male, advanced age, coronary heart disease, pulmonary infections, chronic obstructive pulmonary diseases (COPD), renal insufficiency, ASA classification, anesthesia methods, and length of hospital stay were related to postoperative 1-year death (P<0.05 or 0.01). A total of 127 patients (15.6%) died within 1 year after operation. Multivariate Logistic regression analysis showed age (OR=1.037, 95%CI 1.007-1.068), ASA grade(ASA grade II : OR=1.851, 95%CI 1.238-14.386; ASA grade III : OR=2.092, 95%CI 1.266-16.482; ASA grade IV: OR=15.368, 95%CI 1.626-145. 283), length of hospital stay (OR=1.038, 95%CI 1.015-1.061) were independent risk factors for 1-year mortality. Conclusions The outcome of the elderly hip fracture is poor. The ASA classification is closely related to the incidence of complications, 30-day mortality, and 1-year mortality. Advanced age, ASA grade II, III and IV, hospital length of stay are the independent risk factors for poor prognosis of hip fractures. The ASA classification can be used as a screening tool to intervene for the high-risk population as early as possible. Key words: Hip fractures; Prognosis; Aged

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中华创伤杂志

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11327

期刊介绍： Chinese Journal of Trauma (International Standard Serial Publication Number: ISSN 1001-8050, Domestic Uniform Serial Publication Number: CN 50-1098/R) was founded in September 1985, which is the only high-level medical professional academic journal that can comprehensively and systematically reflect the achievements and development trends of China's traumatology medicine, and has a wide academic influence in China's traumatology medicine community. It has a wide range of academic influence in China's trauma medicine. Chinese Journal of Trauma is a source journal of China Science and Technology Paper Statistics, a source journal of China Science Citation Database (CSCD), a core journal of China Comprehensive Medicine and Health Care, a source journal of China Academic Journals Comprehensive Evaluation Database (CAJCED), a full-text journal of China Journal Full-text Database (CJFD), a core academic journal of China Center for Scientific Evaluation (RCCSE), a core academic journal of China Traumatology and Traumatology Center (CTC), a core academic journal of China Traumatology Center (RCCSE). RCCSE) core academic journals; Chinese Biomedical Journal Database (CMCC), Chinese Biomedical Journal Citation Database (CBJCED), China Journal Network (CJN), China Academic Journals (CD-ROM), Chinese Academic Journals Abstracts (Chinese Edition), Chemical Abstracts of the United States (CA), Index Copernicus of Poland (IC), and Japan Institute of Science and Technology Database (JICST), World Health Organization Western Pacific Region Medical Search (WPRIM) and Russian Journal of Abstracts (ΡЖ) included journals.