李广梅　罗小凤　范马丽

【摘要】 目的：探討老年股骨颈骨折行髋关节置换术（HR）患者术中压疮的相关危险因素及其干预措施。方法：回顾性分析2018年2月-2020年10月于本院行HR治疗的221例老年股骨颈骨折患者的临床资料，收集患者一般资料及临床相关指标，分析行HR治疗的老年股骨颈骨折患者术中压疮的相关危险因素，并总结相应的干预措施。结果：221例患者中发生术中压疮33例（14.93%），未发生术中压疮188例（85.07%）;单因素分析显示：有糖尿病史、年龄≥70岁、体质量指数（BMI）≥24 kg/m2、术中出血量≥60 mL、血清总蛋白≤60 g/L、手术时间≥220 min者术中压疮发生率更高，差异均有统计学意义（P<0.05）;多因素分析显示，有糖尿病史、年龄≥70岁、BMI≥24 kg/m2、术中出血量≥60 mL、血清总蛋白≤60 g/L、手术时间≥220 min均为老年股骨颈骨折行HR患者发生术中压疮的危险因素（P<0.05）。结论：老年股骨颈骨折行HR患者术中压疮发生与年龄、糖尿病史、BMI、术中出血量、血清总蛋白、手术时间密切相关，临床依此制定相应的干预措施，预防术中压疮发生。

【关键词】 老年股骨颈骨折 术中压疮 髋关节置换术

[Abstract] Objective： To investigate the related risk factors and intervention measures of intraoperative pressure ulcers in elderly patients with femoral neck fracture undergoing hip replacement （HR）. Method： The clinical data of 221 elderly patients with femoral neck fracture who received HR treatment in our hospital from February 2018 to October 2020 were retrospectively analyzed. The general information and clinical indicators of the patients were collected to analyze the risk factors related to intraoperative pressure ulcers in the elderly patients with femoral neck fracture who received HR treatment， and the corresponding intervention measures were summarized. Result： Among 221 patients， 33 cases （14.93%） developed intraoperative pressure ulcers， while 188 cases （85.07%） did not. Univariate analysis showed that patients with diabetes history， age ≥70 years old， body mass index （BMI） ≥24 kg/m2， intraoperative blood loss ≥60 mL， serum total protein ≤60 g/L， and operation time ≥220 min had higher incidence of intraoperative pressure ulcers， with statistical significance （P<0.05）. Multivariate analysis showed that diabetes history， age ≥70 years old， BMI≥24 kg/m2， intraoperative blood loss ≥60 mL， serum total protein ≤60 g/L， and operation time ≥220 min were all risk factors for intraoperative pressure ulcers in elderly patients with femoral neck fracture （P<0.05）. Conclusion： The incidence of intraoperative pressure ulcers in elderly HR patients with femoral neck fracture is closely related to age， history of diabetes， BMI， intraoperative blood loss， serum total protein， and operation time. According to this， corresponding intervention measures are formulated clinically to prevent the occurrence of intraoperative pressure ulcers.

[Key words] Senile femoral neck fracture Intraoperative pressure ulcer Hip replacement

First-author’s address： Zhanjiang First Hospital of Traditional Chinese Medicine， Zhanjiang 524043， China

doi：10.3969/j.issn.1674-4985.2021.19.042

髋关节置换术（HR）可缓解髋关节疼痛、纠正关节畸形、重建髋关节功能，是治疗老年股骨颈骨折的常用术式之一[1-2]。但老年患者本身皮肤弹性差、血液循环等生理功能减退、术中长时间保持侧卧位、手术应激、麻醉等因素影响，术中患者易出现急性压疮，直接影响手术疗效，还会增加患者疼痛程度，甚至诱发护患纠纷[3-4]。基于此，本研究回顾性分析2018年2月-2020年10月在本院行HR治疗的221例老年股骨颈骨折患者的临床资料，分析老年股骨颈骨折行HR患者术中压疮的相关危险因素，并以此总结相应的干预措施，为临床制定相应的预防措施提供参考，现报道如下。……