Intertrochanteric Fracture Risk Of Perioperative Complicated By Heart Failure Related Factors

ObjectiveTo investigate the risk factors of perioperative heart failure in elderly patients with intertrochanteric fracture, and to provide a clinical basis for the prevention and treatment of elderly patients with intertrochanteric fracture complicated with heart failure. So as to improve the survival rate of patients and improve the quality of life.MethodsA retrospective analysis of 116 patients with intertrochanteric fractures among the elderly over 80 years from March 2013 to September 2015 in Guangdong Provincial Hospital Bone Two inpatient treatment, according to the inclusion criteria and exclusion criteria,90 cases included in the study. For sex, age, BMI, underlying diseases (hypertension, coronary heart disease, diabetes, cerebral infarction, valvular heart disease, pulmonary edema, hyperlipidemia, hypoproteinemia, anemia, Alzheimer’s disease, high blood pressure heart disease, chronic obstructive pulmonary disease, nephrotic syndrome, Parkinson’s disease), risk factors (infection, arrhythmias, agitation, straining at stool), routine examination (white blood cell count, hemoglobin count, albumin count, oxygen saturation, electrolytes, liver function, renal function and routine checks whether the underlying disease consistent with it), the timing of surgery, surgical, anesthesia, operative time, ASA classification, blood loss, perioperative daily fluid volume, perioperative 37 balance of positive and negative factors of the liquid, perioperative blood transfusion and other first single factor analysis. Statistically significant variables for further multivariate Logistic regression analysis, the factors that determine whether a risk factor for intertrochanteric fracture patients perioperative concurrent onset heart failure, and to establish the regression equation.Results1、90 cases collected in 13 patients with heart failure in the perioperative occurrence, accounting for 14.4%.2、Univariate analysis showed that age and stratified analysis (≥85years), the underlying disease (≥4species) or the occurrence of coronary heart disease, diabetes, heart disease, hypertensive heart disease, anemia, hypoalbuminemia, perioperative positive balance of fluid volume, blood loss (>90 ml), ASA classification (ⅢⅣlevel), the timing of surgery (>5days), hemoglobin counts (<90g/L), elevated white blood cell count, renal insufficiency, electrolyte disorders, overweight, arrhythmias, agitation, infection, straining at stool (fatigue)and other factors chi-square test p<0.05, statistically significant.3、On univariate analysis p<0.05 factor line regression analysis, the regression equation into the selected p<0.05 value of the variable. Display of heart failure and coronary heart disease based perioperative occurrence, valvular heart disease, anemia, underlying diseases combined species≥ 4, arrhythmias, perioperative positive fluid balance amount, ASA classification (Ⅲ Ⅳgrade), hemoglobin count (<90g/L), elevated white blood cell count, renal insufficiency, electrolyte imbalance, straining at stool (fatigue) and other 12 factors p<0.05, statistically significant. Into the regression equation Y(perioperative complicated by heart failure)=-0.371+0.148X5 (coronary heart disease)+0.133X8 (valvular heart disease)+0.065X12 (anemia) +0.092X19 (arrhythmia)+0.085X21 (straining at stool)+0.093X22 (elevated white blood cell count)+0.062X23(hemoglobin count<90g/L)+0.022X26 (electrolyte imbalance)+0.147X28 (renal insufficiency)+0.082X33 (ASA grade Ⅲ Ⅳgrade)+0.082X36(perioperative positive fluid balance)+0.027X38 (combined with underlying diseases^4species).ConclusionCoronary artery disease, valvular heart disease, anemia and merge≥ 4Species underlying diseases, arrhythmia, straining at stool, elevated white blood cell count, hemoglobin count<90g/L, electrolyte disturbances, renal insufficiency, ASA grade Ⅲ Ⅳgrade Wai balancing of positive factors such as the liquid is intertrochanteric fracture perioperative risk factors complicated by heart failure.Therefore, the emphasis medical conditions and general health of patients with fractures of intertrochanteric strengthen clinical rehydration understanding as much as possible for elderly orthopedic perioperative 24 hours of intake and output, in order to understand the patient’s body fluids, try to maintain a liquid or close to negative balance. Fluid therapy CKS balance turned negative balance,interstitial extracellular fluid reabsorption into the circulation, showed significantly increased urination and edema, urine and other liquid fluid volume was significantly greater than the amount that the negative fluid balance.