老人髖骨骨折後發生重大心血管疾病之危險因子探討

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題名:	老人髖骨骨折後發生重大心血管疾病之危險因子探討 Risk factors for cardiovascular events in one year among elder patients with hip fracture
作者:	詹佳孟 Chan, Chia-Meng
貢獻者:	林茂榮
關鍵詞:	髖骨骨折;年長者;心血管疾病 Hip fracture;elderly;cardiovascular events
日期:	2014-06-25
上傳時間:	2019-09-10 12:45:48 (UTC+8)
摘要:	前言：髖骨骨折占所有骨質疏鬆症所引起相關骨折的百分之十四到百分之二十，這類病人在骨折後有一定比例的病人會產生合併症甚至死亡，其在照護上對病人及社會經濟的支出也是一大負擔。雖然如此，大部分的病人可以在接受手術及復健治療後，回復到骨折前的生活及正常功能。然而有文獻提到，有些髖骨骨折的病人在接受手術後有可能產生一些危及生命的重大心血管疾病，例如心肌梗塞或是中風。研究指出，髖骨骨折本身即是未來發生心血管疾病的一個危險因子，但之前的文獻似乎沒有特別探討哪些病人比較容易在髖骨骨折後發生心血管疾病。於是乎，髖骨骨折的病人在手術後發生重大心血管疾病的危險因子仍然不明，希望能藉由這個研究找出可能的危險因子。目的：藉由本研究找出年長者髖骨骨折後，一年內發生重大心血管疾病之危險因子。方法：本研究為一回溯性的世代研究，相關資料藉由回溯病患病歷紀錄而得。本研究在一總床數約800床的醫學中心進行，自2005年1月1日至2011年12月31日這七年間，所有符合ICD-9疾病診斷碼820開頭之病人，也就是各種類型的髖骨骨折病人均初步收案，在符合收案條件及經過排除條件的篩選後，最後進行統計分析。病人的基本資料以及相關用藥還有入院的血液檢查報告，以卡方以及獨立樣本t試驗進行分析。p值小於0.1之變項，進一步以羅吉斯回歸進行分析，最後p值小於0.05之變項，我們定義其為獨立的風險因子。結果：在七年研究期間中，符合初步收案條件的有499位病患，在經過排除後，有445位病患進入我們的最後研究分析。在單變項分析方面，病患有糖尿病病史、不正常的BMI值、術後使用COX-2止痛藥、血液報告顯示較低的血紅素以及腎功能異常這五個變項在兩組病人上有統計上的顯著差異。而進一步以羅吉斯回歸分析的結果，發現病患有糖尿病病史、不正常的BMI值以及術後使用COX-2止痛藥，為年長者髖骨骨折後一年，發生重大心血管疾病的獨立風險因子。結論：年長者髖骨骨折且接受手術的病患，若有糖尿病病史、不正常的BMI值以及術後使用COX-2止痛藥，其有較高的機會在髖骨骨折後一年內得到重大心血管疾病，如心肌梗塞或是缺血性中風。 Introduction: Hip fracture accounts for 14%~20% of all osteoporotic fractures, and result in significant mortality, morbidity, and costs. Most patients could get recovery without any disability after surgery and rehabilitation. However, some patients may suffer from cardiovascular events following the surgery for hip repair and it could be life-threatening. Previous studies found that hip fracture is an independent risk factor for myocardial infarction and stroke, but the individual factors have not been discussed yet. The risk factors associated with cardiovascular events among elder hip fracture patients are still unclear, especially in Taiwanese people. Aim: To investigate the risk factors associated with cardiovascular events in 1 year among elder hip fracture patients. Methods: This is a retrospective cohort study in a single medical center about 800 beds. Patients who were older than 65 years old with hip fracture from January 1, 2005 to December 31, 2011 with a diagnosis of hip fracture and received surgical repair were eligible for inclusion. Patients’ data were abstracted from medical records by trained nurses and the author. Chi-square test or Fisher exact test when appropriate was used for the statistical analysis of categorical variables. Continuous variables were presented as mean (SD) and compared using the independent samples t test. All variables measures with univariate comparison p < 0.1 between two groups were eligible for inclusion in a forward selection multiple logistic regression model, and p value < 0.05 was considered statistically significant. Results: Four hundred and ninety-nine patients were admitted due to hip fracture during study period and 445 patients were enrolled to the final analysis. Twenty-four patients had major cardiovascular events after hip surgery in 1 year. Seven patients had acute myocardial infarction and seventeen patients had ischemic stroke. Patients who had diabetes (p=0.001), COX-2 after surgery (p=0.007), abnormal BMI (p=0.001), low hemoglobin level (p=0.058) and impaired renal function (p=0.047) tended to have a cardiovascular event. In the multiple logistic regression analysis, patients who had diabetes (p=0.030), using COX-2 after surgery (p=0.019) and abnormal BMI (p=0.001) were thought as independent risk factors for cardiovascular events in 1 year. Conclusion: Abnormal BMI, using COX-2 after surgery and diabetes were independent risk factors for major cardiovascular events in one year among elderly patients with hip fracture.
描述:	碩士指導教授-林茂榮委員-馬惠明委員-白璐
資料類型:	thesis
顯示於類別:	[傷害防治學研究所] 博碩士論文

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