2018 年第 4 期 第 13 卷

骨科围术期低氧血症临床分析

Clinical analysis of hypoxemia in orthopedic perioperative patients

作者：李天水张运剑胡萍綦颖罗凌王小燕程洋王晓芳申勤勤张平骥王卓张冰王艳霞刘法永戴丽夏国光

英文作者：

单位：100035北京积水潭医院呼吸与危重症医学科

英文单位：

关键词：低氧血症；围术期；骨科

英文关键词：

• 摘要：

• 目的    分析骨科围术期低氧血症的发病率、常见病因及预后。方法    通过电子病历检索系统，收集2015年1月至2016年12月北京积水潭医院以手术为目的入住骨科病房并发生非一过性低氧血症患者的临床资料，记录患者的入院原因，是否手术，低氧血症时的意识状况、血气分析及预后等资料。结果    2015年1月至2016年12月共纳入创伤、矫形、手外、运动医学、骨肿瘤、脊柱科6个科室131例低氧血症患者，低氧血症发病率为0.28%（131/47 260），病死率为8.4%(11/131)，死亡患者中7例患者出现意识改变。引起围术期低氧血症最常见的骨科原因主要为股骨颈骨折31例、膝关节重度骨性关节炎行膝关节置换术31例、股骨粗隆间骨折20例。导致围术期低氧血症的直接原因主要为肺炎55例（42.0%）和肺栓塞26例（19.8%）。结论    骨科围术期低氧血症是常见且严重的并发症，病死率高，加强骨科围术期低氧血症的防治有重要临床意义。

• Objective    To analyze the incidence, common causes and prognosis of hypoxemia in orthopaedic perioperative patients. Methods    Clinical records of patients who had non-transient hypoxemia during perioperative period of orthopedic surgery in Beijing Jishuitan Hospital from January 2015 to December 2016 were retrospectively analyzed. Occurrences and causes of hypoxemia, consciousness, blood gas status and prognosis of patients were analyzed. Results   Hypoxemia occurred in 131 patients including 59 males and 72 females in departments of traumatology, orthopedics, hand surgery, sports medicine, bone tumour and spinal surgery. Incidence rate of hypoxemia was 0.28%（131/47 260）; fatality rate was 8.4%(11/131); 7 patients had consciousness disorder before they died. Common orthopedic causes of hypoxemia were femoral neck fracture（31 cases）, arthroplasty of severe knee osteoarthritis（31 cases） and intertrochanteric fracture（20 cases）. The main direct causes of hypoxemia were pneumonia［55 cases(42.0%)］ and pulmonary embolism［26 cases(19.8%)］. Conclusion    Hypoxemia is a common and serious complication with high mortality in orthopedic perioperative patients.