【摘要】 目的分析Nottingham量化评分对于评估老年髋部骨折手术病人预后的意义。方法 2016年1月1日～2019年11月30日我院行髋部骨折手术的病人820例,收集病人性别、年龄、体重、身高、体重指数(BMI)、ASA分级、骨折类型、手术类型、麻醉方式、术后VAS疼痛评分、术中失血量、尿量、是否输血、是否使用血管活性药物、是否患有老年痴呆、术前住院时间、术后住院时间、总住院时间、术后是否进入ICU治疗、术前合并症、术后并发症以及转归情况。将所有病人按照Nottingham评分量表分为两组:Nottingham量化评分≤5分组和Nottingham量化评分>5分组,分析Nottingham量化评分对于老年髋部骨折手术预后的影响。结果与Nottingham量化评分≤5分组比较,Nottingham量化评分>5分组年龄明显较大、ASA分级Ⅲ～Ⅳ级的病人比例高、BMI值偏小、头下型骨折所占比例较高、麻醉方式选择更倾向于腰硬联合麻醉和神经阻滞麻醉,差异有统计学意义(P<0.05);Nottingham量化评分>5分组总住院时间显著增加,术后贫血、深静脉血栓(DVT)、术后谵妄、术后心律失常、术后肺部感染、术后脑梗、术后电解质紊乱、术后低氧血症、术后肾功能不全、术后心衰发生比例明显增加及术后转入ICU的比例明显增多,差异有统计学意义(P<0.05)。结论 Nottingham量化评分>5分的老年髋部骨折病人,术后并发症发生率较高,总住院时间明显增加,发展成重症的比例较高,预后较差。运用Nottingham评分量表进行评估找出其中的危险因素提前进行有效干预,将会是改善老年髋部骨折手术病人预后的重要策略。更多还原

【Abstract】 Objective To assess the assess the utility of the Nottingham Hip Fracture Score(NHFS) as a predictor of postoperative complications in elderly patients undergoing hip surgery.Methods NHFS was retrospectively calculated for 820 patients who had undergone hip fracture surgery between January 1 st 2016 and November 30 th 2019.Patients’ gender,age,height,weight,Body Mass Index,ASA class,fracture type,type of surgery and anesthesia,postoperative visual analogue score,intraoperative blood loss and urine output,history of blood transfusion,history of dementia,preoperative hospital stay,postoperative hospital stay,length of hospital stay,admission to ICU,preoperative coexistent diseases,and postoperative complications were compared.According to the NHFS,patients were divided into two groups:NHFS≤5 scores group and NHFS>5 scores group.Results Compared with patients in NHFS≤5 scores group,the patients with NHFS>5 scores group showed significantly higher age and ASA class,lower BMI,and larger proportion of subcephalic fracture and combined spinal-epidural anesthesia(P<0.05).There were significant differences in postoperative anemia,deep vein thrombosis(DVT),delirium,arrhythmia,pulmonary infection,cerebral infarction,electrolyte disturbance,hypoxemia,renal dysfunction,heart failure,and admission to ICU between the two groups(P<0.05).Conclusion Postoperative complications are more likely to occur in patients with higher NHFS,which might delay the hospital length of stay with poor total outcome.The NHFS is a reliable tool for predicting prognosis.It may be useful for discharge planning,and for the design of future research trials.更多还原