老年髋部骨折术后发生急性肾损伤的临床特点及危险因素分析

目的 探讨老年髋部骨折术后发生急性肾损伤(AKI)的临床特点及危险因素分析。方法 髋部骨折手术患者470例,根据AKI的诊断标准将患者分为非AKI组(276例)和AKI组(194例)。检测两组白细胞(WBC)、红细胞(RBC)、血肌酐(SCr)、血尿素氮(BUN)、白蛋白(ALB)、肾小球滤过率(eGFR)、血红蛋白(Hb)、酸碱平衡(pH)、动脉血氧分压(PaO₂)、动脉血二氧化碳分压(PaCO₂)、碳酸氢根(HCO3)、血清钾(K⁺)、血清钙(Ca²⁺)并对相关预后危险因素进行分析。结果 AKI组与非AKI组冠心病、糖尿病、低血压、WBC、ALB、eGFR指标比较差异具有统计学意义(P<0.05);AKI组手术时间、术中出血量、麻醉时间均高于非AKI组(P<0.05);AKI组SCr、BUN、住院时间指标高于非AKI组(P<0.05);AKI组 24 h 尿量指标低于非AKI组(P<0.05);AKI组pH、HCO3、K⁺指标均高于非AKI组(P<0.05);AKI组PaO₂、PaCO₂、Ca²⁺均低于AKI组(P<0.05);冠心病、糖尿病、低血压、WBC、ALB、eGFR、住院时间是老年患者髋部手术发生AKI的预后独立危险因素(P<0.05)。结论 老年患者髋部骨折术前具有冠心病、糖尿病、低血压等基础疾病,术后有发生AKI较高的风险,导致患者的治疗难度增大,造成死亡风险增加,对预后恢复有影响。

Clinical features and risk factors of acute kidney injury after hip fracture in the elderly

Objective To investigate clinical characteristics and risk factors of acute kidney injury(AKI) after hip fracture in the elderly. Methods Four hundred and seventy patients undergoing hip fracture surgeries were selected. According to the criteria for acute kidney injury, the patients were divided into non-AKI group (276 cases) and AKI group (194 cases). The white blood cells (WBC), red blood cells (RBC), serum creatinine (SCr), blood urea nitrogen (BUN), albumin (ALB), glomerular filtration rate (eGFR), hemoglobin (Hb) indicators, acid-base balance (pH), partial pressure of arterial oxygen (PaO₂), partial pressure of arterial carbon dioxide (PaCO₂), bicarbonate radical (HCO3), serum potassium (K⁺), serum calcium (Ca²⁺) indicators were detected between the two groups, and related prognostic risk factors were analyzed. Results Coronary heart disease, diabetes, hypotension, the index of WBC, ALB. GFR in the two groups were statistically significant difference (P<0.05). Compared the non-AIK group, the operation duration, intraoperative blood loss, and anesthesia duration in AKI group were significantly higher (P<0.05). SCr, BUN and length of length of hospitalization in AKI group were significantly higher (P<0.05). 24-hour urine output in AKI group were significantly lower (P<0.05). pH, HCOs and K⁺ in AKI group were significantly higher (P<0.05). PaO₂, PaCO₂, and Ca²⁺ of AKI group were significantly lower (P<0.05). The coronary heart disease, diabetes, hypotension, WBC, ALLB and eGFR, length of Length of hospitalization were independent risk factors for AKI in hip surgery in elderly patients (P<0.05). Conclusion If the elderly patients have underlying diseases involving coronary heart disease, diabetes, and hypotension before hip fracture surgeries, they would have a higher risk of post-operative AKI. The treatment for such elderly patients become more difficult and increase the risk of death which will have an impact on the prognosis recovery.