老年髋部骨折术后发生急性肾损伤的临床特点及危险因素分析

doi:10.3969/j.issn.1004-583X.2021.05.011

摘要/Abstract

摘要：

目的探讨老年髋部骨折术后发生急性肾损伤(AKI)的临床特点及危险因素分析。方法髋部骨折手术患者470例,根据AKI的诊断标准将患者分为非AKI组(276例)和AKI组(194例)。检测两组白细胞(WBC)、红细胞(RBC)、血肌酐(SCr)、血尿素氮(BUN)、白蛋白(ALB)、肾小球滤过率(eGFR)、血红蛋白(Hb)、酸碱平衡(pH)、动脉血氧分压(PaO₂)、动脉血二氧化碳分压(PaCO₂)、碳酸氢根(HCO3)、血清钾(K⁺)、血清钙(Ca²⁺)并对相关预后危险因素进行分析。结果 AKI组与非AKI组冠心病、糖尿病、低血压、WBC、ALB、eGFR指标比较差异具有统计学意义(P<0.05);AKI组手术时间、术中出血量、麻醉时间均高于非AKI组(P<0.05);AKI组SCr、BUN、住院时间指标高于非AKI组(P<0.05);AKI组 24 h 尿量指标低于非AKI组(P<0.05);AKI组pH、HCO3、K⁺指标均高于非AKI组(P<0.05);AKI组PaO₂、PaCO₂、Ca²⁺均低于AKI组(P<0.05);冠心病、糖尿病、低血压、WBC、ALB、eGFR、住院时间是老年患者髋部手术发生AKI的预后独立危险因素(P<0.05)。结论老年患者髋部骨折术前具有冠心病、糖尿病、低血压等基础疾病,术后有发生AKI较高的风险,导致患者的治疗难度增大,造成死亡风险增加,对预后恢复有影响。

关键词: 急性肾损伤, 骨折术后, 预后

Abstract:

Objective To investigate clinical characteristics and risk factors of acute kidney injury(AKI) after hip fracture in the elderly. Methods Four hundred and seventy patients undergoing hip fracture surgeries were selected. According to the criteria for acute kidney injury, the patients were divided into non-AKI group (276 cases) and AKI group (194 cases). The white blood cells (WBC), red blood cells (RBC), serum creatinine (SCr), blood urea nitrogen (BUN), albumin (ALB), glomerular filtration rate (eGFR), hemoglobin (Hb) indicators, acid-base balance (pH), partial pressure of arterial oxygen (PaO₂), partial pressure of arterial carbon dioxide (PaCO₂), bicarbonate radical (HCO3), serum potassium (K⁺), serum calcium (Ca²⁺) indicators were detected between the two groups, and related prognostic risk factors were analyzed. Results Coronary heart disease, diabetes, hypotension, the index of WBC, ALB. GFR in the two groups were statistically significant difference (P<0.05). Compared the non-AIK group, the operation duration, intraoperative blood loss, and anesthesia duration in AKI group were significantly higher (P<0.05). SCr, BUN and length of length of hospitalization in AKI group were significantly higher (P<0.05). 24-hour urine output in AKI group were significantly lower (P<0.05). pH, HCOs and K⁺ in AKI group were significantly higher (P<0.05). PaO₂, PaCO₂, and Ca²⁺ of AKI group were significantly lower (P<0.05). The coronary heart disease, diabetes, hypotension, WBC, ALLB and eGFR, length of Length of hospitalization were independent risk factors for AKI in hip surgery in elderly patients (P<0.05). Conclusion If the elderly patients have underlying diseases involving coronary heart disease, diabetes, and hypotension before hip fracture surgeries, they would have a higher risk of post-operative AKI. The treatment for such elderly patients become more difficult and increase the risk of death which will have an impact on the prognosis recovery.

Key words: acute kidney injury, post-operative hip fracture surgery, prognostic

中图分类号:

R692.5

张琳丽, 麻晓红. 老年髋部骨折术后发生急性肾损伤的临床特点及危险因素分析[J]. 临床荟萃, 2021, 36(5): 442-445.

Zhang Linli, Ma Xiaohong. Clinical features and risk factors of acute kidney injury after hip fracture in the elderly[J]. Clinical Focus, 2021, 36(5): 442-445.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2021.05.011

https://huicui.hebmu.edu.cn/CN/Y2021/V36/I5/442

图/表 5

参考文献 14

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组别		例数		性别(例)			年龄(岁)			体重指数 (kg/m²)		吸烟史 [例(%)]		冠心病史 [例(%)]		高血压史 [例(%)]
组别		例数		男		女	年龄(岁)			体重指数 (kg/m²)		吸烟史 [例(%)]		冠心病史 [例(%)]		高血压史 [例(%)]
AKI组		194		102		92	65.27±6.31			24.61±1.31		18(9.3)		14(7.2)		16(8.3)
非AKI组		276		140		136	65.33±5.29			24.42±1.22		32(11.6)		31(11.2)		17(6.2)
t/χ²值				0.157			0.112			1.612		0.643		6.422		0.761
P值				0.692			0.911			0.108		0.423		0.011		0.383
组别	例数		糖尿病史 [例(%)]		低血压史 [例(%)]			WBC (×10⁹/L)	RBC (×10⁹/L)		ALB (g/L)		Hb (g/L)		eGFR [ml/(min·1.73 m²)]
AKI组	194		43(22.2)		47(24.2)			13.82±0.78	3.66±0.77		42.22±2.18		110.53±14.48		53.11±16.32
非AKI组	276		20(7.3)		11(4.0)			6.43±0.65	3.65±0.83		33.29±1.97		110.32±12.31		71.31±11.51
t/χ²值			21.840		43.150			111.600	0.133		46.290		0.169		14.180
P值			<0.01		<0.01			<0.01	0.895		<0.01		0.866		<0.01

组别		例数		性别(例)			年龄(岁)			体重指数 (kg/m²)		吸烟史 [例(%)]		冠心病史 [例(%)]		高血压史 [例(%)]
组别		例数		男		女	年龄(岁)			体重指数 (kg/m²)		吸烟史 [例(%)]		冠心病史 [例(%)]		高血压史 [例(%)]
AKI组		194		102		92	65.27±6.31			24.61±1.31		18(9.3)		14(7.2)		16(8.3)
非AKI组		276		140		136	65.33±5.29			24.42±1.22		32(11.6)		31(11.2)		17(6.2)
t/χ²值				0.157			0.112			1.612		0.643		6.422		0.761
P值				0.692			0.911			0.108		0.423		0.011		0.383
组别	例数		糖尿病史 [例(%)]		低血压史 [例(%)]			WBC (×10⁹/L)	RBC (×10⁹/L)		ALB (g/L)		Hb (g/L)		eGFR [ml/(min·1.73 m²)]
AKI组	194		43(22.2)		47(24.2)			13.82±0.78	3.66±0.77		42.22±2.18		110.53±14.48		53.11±16.32
非AKI组	276		20(7.3)		11(4.0)			6.43±0.65	3.65±0.83		33.29±1.97		110.32±12.31		71.31±11.51
t/χ²值			21.840		43.150			111.600	0.133		46.290		0.169		14.180
P值			<0.01		<0.01			<0.01	0.895		<0.01		0.866		<0.01

组别	例数	手术时间 (min)	术中出血量 (ml)	麻醉时间 (min)
AKI组	194	131.53±12.42	110.33±11.42	142.45±34.28
非AKI组	276	56.38±11.42	84.41±12.13	122.61±21.43
t值		22.517	27.342	19.487
P值		0.001	0.001	0.001

组别	例数	手术时间 (min)	术中出血量 (ml)	麻醉时间 (min)
AKI组	194	131.53±12.42	110.33±11.42	142.45±34.28
非AKI组	276	56.38±11.42	84.41±12.13	122.61±21.43
t值		22.517	27.342	19.487
P值		0.001	0.001	0.001

组别	例数	SCr(μmol/L)	BUN(mmol/L)	术后24 h尿量(ml)	住院时间(d)
AKI组	194	113.96±32.28	12.78±3.28	441.42±76.48	20.33±2.14
非AKI组	276	81.32±9.21	6.33±1.24	1 210.37±118.16	15.33±2.32
t(t’)值		16.392	6.197	71.912	5.139
P值		0.001	0.021	0.001	0.034