老年股骨转子间骨折术前不明原因发热的相关因素分析

目的:探讨老年股骨转子间骨折术前不明原因发热相关因素,为临床围手术期管理提供思路。方法:回顾分析2015年8月至2018年8月采用髓内钉固定治疗156例股骨股骨转子间骨折的病历资料,根据术前测量是否发热分为发热组与未发热组。发热组80例,男26例,女54例,年龄60～93(75.063±13.082)岁;未发热组76例,男39例,女37例,年龄60～96(74.763±13.692)岁。观察所有患者性别、年龄、基础病、白细胞、中性粒细胞百分比、血红蛋白、C-反应蛋白、D-二聚体、白蛋白指标,并进行单因素和多因素分析。结果:单因素分析显示性别、血红蛋白、C-反应蛋白对术前发热有影响,其他指标无影响;多因素分析性别及C-反应蛋白对发热可能存在影响。C-反应蛋白每上升1个单位,发热的概率增长1.2%(P=0.05);女性与男性在发热概率上无明显区别(P=0.061)。结论:C-反应蛋白是老年股骨转子间骨折患者术前发热的独立危险因素,C-反应蛋白异常提示患者术前发热可能性较大,围手术期管理应重视对C-反应蛋白的监测并尽早干预。

Analysis of the related factors of fever of unknown causes before operation of intertrochanteric fracture in the elderly

Objective: To explore the related factors of fever of unknown causes before operation of intertrochanteric fracture of femur in the elderly. Methods: From August 2015 to August 2018,156 cases of intertrochanteric fracture of femur were treated by intramedullary nail fixation. According to the preoperative measurement,whether there was fever was divided into fever group and non fever group. There were 80 cases in fever group,26 males and 54 females,aged 60 to 93 (75.063±13.082) years; 76 cases in non fever group,39 males and 37 females,aged 60 to 96 (74.763±13.692) years. All patients'' sex,age,basic diseases,WBC,NE%,Hb,CRP,D-dimer and ALB were observed for single factor analysis and multi factor analysis. Results: Single factor analysis showed that gender,Hb,CRP had influence on preoperative fever,but other indexes had no influence; multi factor analysis showed that gender and CRP might have influence on fever. The probability of fever increased by 1.2%(P=0.050) for every increase of CRP,and there was no significant difference between female and male in the probability of fever(P=0.061). Conclusion: CRP is an independent risk factor of preoperative fever in the elderly patients with intertrochanteric fracture of femur. The abnormality of CRP indicates that patients are more likely to have preoperative fever. Perioperative management should pay attention to the monitoring of CRP and early intervention.