【摘要】 目的探讨高龄髋部骨折患者髋关节置换术围手术期风险和多学科协作处理措施及效果。方法笔者自2011-09—2015-02对135例高龄髋部骨折行髋关节置换术。入院后详细询问病史及术前检查,了解基础病,通过多学科协作处理作好充分的术前准备,在恰当的麻醉下进行髋关节置换术,术中加强各系统监测及早期干预,术后继续各系统监测及并发症防治。结果所有患者均顺利完成手术,术中血压下降58例,心律失常32例,血氧下降36例。术后肺部感染23例,心功能不全31例,心律失常42例,低蛋白血症93例,贫血87例,电解质紊乱64例,认知功能障碍52例,急性脑血管意外8例,多系统异常68例。经多学科协作处理,除2例多器官功能衰竭放弃治疗外,其余患者均康复出院。结论高龄髋部骨折患者行髋关节置换术风险较大,围手术期多学科协作处理是其成功的重要保证。更多还原

【Abstract】 Objective To investigate the multidisciplinary treatment for the aged patients with hip fractures who were treated by hip arthroplasty in the perioperative period. Methods Totally 135 patients with hip fractures who were elder than 85 years and underwent hip arthroplasty were involved in this study from Sept. 2011 to Feb. 2015. The process of injury and the medical history for possible diseases and potential low-function in detail after hospitalization were recorded. All cases were treated by hip arthroplasty under appropriate anesthesia after sufficient preoperative examination and enhancement of the systems by multidisciplinary approach. Index of the correlated system was monitored and improved early along with a shorter operative time during surgery. Postoperative complications were prevented and cured in monitoring for all systems. Results All the patients were operated successfully. Hypotension was observed in 58 patients during surgery, arrhythmia in 32 patients,hypoxemia in 36 patients. Pulmonary infection was observed in 23 patients after surgery, heart failure in 31 patients,arrhythmia in 42 patients, hypoproteinemia in 93 patients, anemia in 87 patients, electrolyte disturbance in 64 patients,cognitive dysfunction in 52 patients, acute cerebrovascular accidents in 8 patients, multi system abnormalities in 68 patients.Besides 2 patients who gave up on therapy because of multiple organ failure, all other patients recovered well enough to be discharged to home with the help of multidisciplinary. Conclusion Although the operative risk for the aged patients with hip fractures who were treated by hip arthroplasty is high, the multidisciplinary treatment is an important safety guarantee for the operation.更多还原