高龄髋部骨折患者消化道并发症的早期干预

作者：洪方业，叶斌，黄朝辉，张海林，张弛。

【摘要】 目的 探讨高龄患者髋部骨折后消化道并发症早期干预的临床意义。方法 对247例高龄患者髋部骨折消化道并发症发生情况进行统计学分析。结果 247例患者中发生胃肠道并发症48例，其中15例预防性使用抗酸剂，33例未预防性使用抗酸剂，未发生胃肠道并发症199例，其中121例预防性使用抗酸剂，78例未预防性使用抗酸剂，将发生胃肠道并发症患者作为患者组，未发生胃肠道并发症患者为对照组。预防性使用抗酸剂患者为作非暴露组，未预防性使用抗酸剂患者作为暴露组进行统计学分析，结果2组差异有显著性(P0.005)，表明预防性使用抗酸剂对减少高龄患者髋部骨折后消化道并发症有明显作用。结论 早期干预能降低高龄患者髋部骨折后消化道并发症发生率。

【关键词】 髋部骨折; 胃肠道; 并发症; 早期干预; 老年人。

【Abstract】 Objective To investigate the clinical significance of early intervention in aged hip fracture patients in order to prevent gastrointestinal complications.Methods Gastrointestinal complications in 247 cases of aged patients with hip fracture were investigated and statistically analyzed.Results Of the 247 cases, 48 developed gastrointestinal complications, of whom 15 were preventively administered with antiacid while the other 33 were not. Among the 199 cases who were not afflicted with gastrointestinal complications, 121 were tackled with preventive antiacid while the other 78 were not. The cases with gastrointestinal complications were classified as an experimental group and those with no gastrointestinal complications as a control group. The patients with preventive use of antiacid were taken as a nonexposure group and those with no preventive use of antiacid as an exposure group. The gastrointestinal complications in the 247 cases of hip fractures were investigated and analyzed in the way of statistics. The result showed remarkable difference (P0.005). There were significant difference between the experiment group and the control group, which indicates that the early use of antiacid to the aged patients with hip fracture might reduce the rate of gastrointestinal complications.Conclusion The early use of antiacid as an intervenient measure can reduce the gastrointestinal complications caused by hip fracture in elderly patients.

【Key words】 Hip fracture; Gastrointestinal tract; Complication; Early intervention; Aged。

高龄患者骨质疏松，常因轻微的外伤而引起髋部骨折。老年人身体各脏器机能下降，免疫功能低下，原有并存疾病，以及各种并发症的影响，髋部骨折后死亡率很高。Deakin等[1]调查显示，髋部骨折后1年死亡率高达33%。Roberts等[2]统计显示，现在老年髋部骨折后30 d死亡率为9.8%，1年死亡率为30.7%。高龄患者骨折术后常见并发症有心脏的(包括继发性心衰/心律失常);感染(伤口感染/尿道感染/肺炎);出血性的(伤口血肿/胃肠道出血);栓塞性(深静脉血栓/肺栓塞)和其它(尿潴留/肾脏衰竭/便秘/褥疮/过敏反应/精神症状/电解质紊乱等)。随着医学水平的的发展，对老年患者骨折后并发症早期进行干预，能明显降低患者骨折后并发症发生，从而降低高龄患者髋部骨折后死亡率。在临床工作中，高龄患者髋部骨折后胃肠道并发症并未得到足够重视，本文对高龄患者胃肠道并发症早期干预作一探讨。

1 资料与方法。

1.1 资料 收集我科2006～2008年高龄髋部骨折病例247例，年龄大于60岁，骨折时间不超过10 d，其中年龄60～75岁29例;75岁以上218例;男69例，女178例，股骨颈骨折131例，转子间骨折116例。

1.2 方法 对247例患者在性别、年龄、抗酸剂使用情况及胃肠道并发症发生情况进行记录并输入电脑通过EXCEL2003制表，将发生胃肠道并发症患者作为患者组，未发生胃肠道并发症患者为对照组，预防性使用抗酸剂患者作为非暴露组，未预防性使用抗酸剂患者作为暴露组，并对数据进行统计学分析，经过卡方检验，从而得出预防性使用抗酸剂对高龄患者髋部骨折后消化道并发症几率之间的联系。

2 结果。

术后胃肠道反应包括：恶心、呕吐、腹泻、呕血、便血等消化道功能紊乱、应激性溃疡上消化道出血表现。我们通过早期预防性使用抗酸剂对高龄患者骨折后胃肠道并发症进行早期干预，通过对疗效观察及记录，进行统计学处理，预防性使用抗酸剂和对照组高龄患者髋部骨折后出现胃肠道反应对比情况，见表1。表1 2组胃肠道反应情况比较。