2023 年第 10 期 第 18 卷

老年髋部骨折患者心血管合并疾病对术后主要不良心血管事件的影响

Influence of cardiovascular comorbidities on major adverse cardiovascular events in elderly patients with hip fracture

作者：孙明曜1李曼2杨明辉3胡三保1

英文作者：Sun Mingyao1 Li Man2 Yang Minghui3  Hu Sanbao1

单位：1首都医科大学附属北京安贞医院骨科，北京100029；2中日友好医院麻醉科，北京100029；3北京积水潭医院骨科，北京100035

英文单位：1Department of Orthopedics Beijing Anzhen Hospital Capital Medical University Beijing 100029 China; 2Department of Anesthesiology China-Japan Friendship Hospital Beijing 100029 China; 3Department of Orthopedics Beijing Jishuitan Hospital Beijing 100035 China

关键词：髋部骨折；心血管合并疾病；主要不良心血管事件

英文关键词：Hipfracture;Cardiovascularcomorbidities;Majoradversecardiovascularevents

• 摘要：

• 目的  分析老年髋部骨折患者术前心血管合并疾病对术后主要不良心血管事件（MACE）的影响。方法  回顾性分析2015年1月至2021年1月于首都医科大学附属北京安贞医院骨科住院的老年髋部骨折患者资料。比较2组患者人口统计学数据、手术情况、合并疾病，根据术前是否合并心血管疾病，将患者分为心血管疾病组与非心血管疾病组。研究主要终点为术后30 d内MACE发生情况，次要终点为住院期间死亡。根据术前是否合并多类心血管疾病，将心血管病组分为多心血管疾病组与单心血管疾病组。分析不同类型心血管疾病对术后MACE的影响。结果  本研究共纳入445例患者，其中心血管疾病组183例、非心血管疾病组262例。心血管疾病组美国麻醉医师协会分级≥3级、高血压病、高脂血症、脑血管病、肾功能不全、改良心脏危险指数≥1比例均高于非心血管疾病组（均P＜0.05）。445例患者中共57例（12.8%）术后发生MACE，心血管疾病组MACE、缺血性心血管事件、心律失常、心力衰竭发生率均高于非心血管疾病组（均P＜0.05），心血管疾病组与非心血管疾病组死亡率比较差异无统计学意义（P=0.109）。多心血管疾病组共43例患者、单心血管疾病组共140例患者。多心血管疾病组和单心血管疾病组MACE发生率均高于非心血管疾病组（P＜0.05）。多因素Logistic回归分析结果显示，术前合并冠状动脉粥样硬化性心脏病是术后缺血性心血管事件的独立危险因素（比值比=2.358,95%置信区间：1.185~4.693），术前合并心律失常是术后心律失常的独立危险因素（比值比=4.817,95%置信区间：1.373~16.898），术前合并心律失常（比值比=4.604,95%置信区间：1.364~15.542）或瓣膜病（比值比=6.714,95%置信区间：1.674~26.947）是术后心力衰竭的独立危险因素（均P＜0.05）。结论  术前心血管合并疾病是老年髋部骨折患者术后MACE发生的独立危险因素，不同的心血管疾病类型对术后各类MACE的影响差异鲜明。

• Objective  To analyze the influence of preoperative cardiovascular comorbidities on postoperative major adverse cardiovascular events (MACE) in elderly patients with hip fracture. Methods  The data of elderly patients with hip fracture admitted to Department of Orthopedics, Beijing Anzhen Hospital, Capital Medical University from January 2015 to January 2021 were retrospectively analyzed.  The demographic data, surgical conditions and comorbidities were compared between the two groups. Patients were divided into cardiovascular disease group and non cardiovascular disease group according to whether they had cardiovascular disease before surgery. The major end point was MACE with 30 d after surgery, and the second end point was death during hospital. Cardiovascular disease group was divided into multi-cardiovascular group and mono-cardiovascular disease group according to whether they had multiple cardiovascular diseases. The effects of different types of cardiovascular diseases on postoperative MACE were analyzed. Results  A total of 445 patients were included in the study, including 183 cases in cardiovascular disease group and 262 cases in non cardiovascular group. Rates of American Society of Anesthesiologists stage ≥3, hypertension, hyperlipidemia, cerebrovascular disease, renal insufficiency and revised cardiac risk index ≥1 in cardiovascular disease group were higher than those in non cardiovascular disease group (all P<0.05). There were 57 cases (12.8%) of 445 patients with postoperative MACE. Rates of MACE, ischemic cardiovascular events, arrhythmias, and heart failure in cardiovascular disease group were higher than those in non cardiovascular disease group (all P<0.05). There was no significant difference in death rate between cardiovascular disease group and non cardiovascular disease group (P=0.109). There were 43 cases in multi-cardiovascular disease group and 140 in mono-cardiovascular disease group. The rate of MACE in multi-cardiovascular disease group and mono-cardiovascular disease group was higher than that in non cardiovascular disease group (P<0.05). Multivariate Logistic regression analysis showed that preoperative coronary atherosclerotic heart disease (odds ratio=2.358, 95% confidence interval: 1.185-4.693) was an independent risk factor of postoperative ischemic cardiovascular events, preoperative arrhythmia (odds ratio=4.817, 95% confidence interval: 1.373-16.898) was independent risk factor of postoperative arrhythmia, and preoperative arrhythmia (odds ratio=4.604, 95% confidence interval: 1.364-15.542) or valvular disease (odds ratio=6.714, 95% confidence interval: 1.674-26.947) were independent risk factors of postoperative heart failure (all P<0.05). ConclusionsPreoperative cardiovascular comorbidities are independent risk factors for postoperative MACE in elderly patients with hip fracture. Different types of cardiovascular diseases have distinct effects on postoperative MACE.