Epidemiological characteristics of 58 elderly fracture patients with in-hospital acute cerebral infarction before operation

doi:10.3969/j.issn.1004-583X.2023.05.009

Abstract

Abstract:

Objective To investigate the epidemiological characteristics of in-hospital acute cerebral infarction in elderly patients with fractures before operation. Methods A total of 18,435 elderly patients undergoing fracture surgery in our hospital from January 1, 2016 to October 31, 2021 were retrospectively investigated, among whom 58 patients had acute cerebral infarction before surgery. Their medical records included general information, first detected laboratory indicators on admission, time from injury to admission, time from admission to operation, time of cerebral infarction, etc. The epidemiological status of preoperative acute cerebral infarction in patients was analyzed, and the mechanism and risk factors of preoperative acute cerebral infarction in elderly patients with fractures were described and analyzed. Results The incidence of in-hospital acute cerebral infarction in elderly patients with fractures was 0.314%. Among 58 recruited patients, there were 19 males (32.8%) and 39 females (67.2%), with a male to female ratio of 1∶2.05. The mean age of them was (74.0±1.3) years, and 40 patients (69.0%) were over 75 years.There were 47 cases of hip fractures (81.0%), 3 cases of distal femoral fractures (5.2%), 3 cases of humeral fractures (5.2%), 2 cases of femoral shaft fractures (3.4%), 2 cases of olecranon fractures (3.4%) and 1 case of proximal tibia fracture (1.7%). The onset time of cerebral infarction ranged 1-7 days, and 35 cases (60.3%) occurred within 72 hours. Most of the abnormal laboratory indicators detected for the first time on admission were hemoglobin, serum C-reactive protein, serum homocysteine and serum albumin. Anemia was the most-common complication during hospitalization (70.7%), followed by lower extremity deep vein thrombosis (56.9%), electrolyte disturbance (43.1%), hypoproteinemia (41.7%) and pulmonary infection (37.9%). Conclusion Acute cerebral infarction mostly occurs within 72 hours in elderly patients with fractures, and hip fracture is the more common type in female patients ≥75 years old. Laboratory indicators detected for the first time on admission should be thoroughly evaluated, and targeted measures should be taken to prevent complications and reduce the incidence of acute cerebral infarction before operation.

Key words: elderly fracture, preoperative, acute cerebral infarction, epidemiology

CLC Number:

R683

Zhou Qi, Zhu Yanbin, Li Weining, Li Shuhan, Zhang Xiuguo. Epidemiological characteristics of 58 elderly fracture patients with in-hospital acute cerebral infarction before operation[J]. Clinical Focus, 2023, 38(5): 438-443.

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URL: https://huicui.hebmu.edu.cn/EN/10.3969/j.issn.1004-583X.2023.05.009

https://huicui.hebmu.edu.cn/EN/Y2023/V38/I5/438

Figures/Tables 5

References 27

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变量	男	女	总计
吸烟[例(%)]
是	6(10.3)	1(1.7)	7(12.1)
否	13(22.4)	38(65.5)	51(87.9)
饮酒[例(%)]
是	1(1.7)	0(0.00)	1(1.7)
否	18(31.0)	39(67.2)	57(98.3)
年龄(岁)	75.3±1.8	73.4±1.7	74.0±1.3
BMI(kg/m²)	23.6±0.7	24.8±0.7	24.4±0.5
ACCI	5.6±0.3	5.3±0.2	5.4±0.2
骨折部位
股骨粗隆间骨折	10(17.2)	16(27.6)	26(44.8)
股骨颈骨折	5(8.6)	16(27.6)	21(36.2)
股骨远端骨折	1(1.7)	2(3.4)	3(5.2)
肱骨骨折	1(1.7)	2(3.4)	3(5.2)
股骨干骨折	1(1.7)	1(1.7)	2(3.4)
尺骨鹰嘴骨折	1(1.7)	1(1.7)	2(3.4)
胫骨上段骨折	0(0.0)	1(1.7)	1(1.7)
手术类型
内固定术	10(17.2)	23(39.7)	33(56.9)
关节置换术	6(10.3)	11(19)	17(29.3)
骨牵引术	3(5.2)	5(8.6)	8(13.8)

变量	男	女	总计
吸烟[例(%)]
是	6(10.3)	1(1.7)	7(12.1)
否	13(22.4)	38(65.5)	51(87.9)
饮酒[例(%)]
是	1(1.7)	0(0.00)	1(1.7)
否	18(31.0)	39(67.2)	57(98.3)
年龄(岁)	75.3±1.8	73.4±1.7	74.0±1.3
BMI(kg/m²)	23.6±0.7	24.8±0.7	24.4±0.5
ACCI	5.6±0.3	5.3±0.2	5.4±0.2
骨折部位
股骨粗隆间骨折	10(17.2)	16(27.6)	26(44.8)
股骨颈骨折	5(8.6)	16(27.6)	21(36.2)
股骨远端骨折	1(1.7)	2(3.4)	3(5.2)
肱骨骨折	1(1.7)	2(3.4)	3(5.2)
股骨干骨折	1(1.7)	1(1.7)	2(3.4)
尺骨鹰嘴骨折	1(1.7)	1(1.7)	2(3.4)
胫骨上段骨折	0(0.0)	1(1.7)	1(1.7)
手术类型
内固定术	10(17.2)	23(39.7)	33(56.9)
关节置换术	6(10.3)	11(19)	17(29.3)
骨牵引术	3(5.2)	5(8.6)	8(13.8)

变量	平均值
受伤至入院时间(s)	0.5(0.2,3.0)
脑梗发生时间[例(%)]
<24 h	2(3.4)
24~36 h	22(38.0)
36~72 h	11(19.0)
>72 h	23(40.0)
入院至手术时间(d)	9.5(6.0,14.0)
住院时长(d)	18(13.0,27.3)
入院收缩压(mmHg)	146±3.3
入院舒张压(mmHg)	85(73.3, 94.2)
脑梗前一天收缩压(mmHg)	148±2.6
脑梗前一天舒张压(mmHg)	82±2.0

变量	平均值
受伤至入院时间(s)	0.5(0.2,3.0)
脑梗发生时间[例(%)]
<24 h	2(3.4)
24~36 h	22(38.0)
36~72 h	11(19.0)
>72 h	23(40.0)
入院至手术时间(d)	9.5(6.0,14.0)
住院时长(d)	18(13.0,27.3)
入院收缩压(mmHg)	146±3.3
入院舒张压(mmHg)	85(73.3, 94.2)
脑梗前一天收缩压(mmHg)	148±2.6
脑梗前一天舒张压(mmHg)	82±2.0

脑梗死部位	基底节		枕叶		顶叶		小脑		额叶		颞叶		丘脑		脑室旁		半卵圆孔		放射冠		大脑半球		心源性
脑梗死部位	左	右	左	右	左	右	左	右	左	右	左	右	左	右	左	右	左	右	左	右	左	右	心源性
例数	3	7	4	3	4	3	8	1	1	5	2	4	3	1	1	2	0	2	2	0	0	1	1
合计(例)	10		7		7		9		6		6		4		3		2		2		1		1
占比(%)	17.2		12.1		12.1		15.5		10.3		10.3		6.9		5.2		3.4		3.4		1.7		1.7