Effects Of Intertrochanteric Fracture And Surgery On Cardiovascular System In Elderly Patients And Noninvasive Monitoring With PPG

Objective:Intertrochanteric fracture is one of the most severe fractures with high mortality and disability rate in the elderly.Cardiovascular events and pulmonary infection are the most common causes for death.Intramedullary nailing is the most common treatment for intertrochanteric fracture.The cardiovascular system of the elderly may be affected more by insertion of intramedullary nail because of the decline of respiratory and cardiovascular function.The primary objective of this study was to explore the effect of insertion of unreamed intramedullary nail on cardiovascular system and the mortality in the elderly.Methods:We evaluated consecutive elderly patients with intertrochanteric fractures admitted to the five Department of orthopedics of General Hospital of the army treated with unreamed intramedullary nailing from September 5,2015 to December 5,2015.Their relevant data and waveform on the second day after admission,before and after insertion of nail and on the second day after operation were recorded.To monitor the blood pressure,the patients carried a catheter with a pressure head during surgery.After analyzing and comparing data,we observed the difference between invasive and non-invasive monitor,effect of insertion of unreamed intramedullary nail on the cardiovascular system in the elderly patients.And medical records were scrutinised for death during first year after surgery.Result:Before and after insertion of intramedullary nail,the mean values of systolic pressure and the median values of diastolic pressure were significantly(P < 0.05)lower from the finger than the intra-arterial catheter.The line relating systolic and diastolic pressure by intra-arterial catheter before insertion was y=1.5x-45(r2=0.837)and y=1.2x-40(r2=0.746),after insertion was y=1.2x-36(r2=0.807)and y=1.2x-18(r2=0.745).After insertion of intramedullary nail,the mean change in systolic blood pressure was-6.97±10.35mmHg(P<0.05).The median change in diastolic blood pressure was-2.50(-5.36-0.00)mmHg(P<0.05).The mean change of heart rate was-1.78 ± 5.08(P>0.05)and in rate-pressure product was-760.16±1187.97(mmHg·8)4)9)-1)(P<0.05).There was no significant difference in the changes of vascular resistance before and after insertion of intramedullary nail.There was no significant difference in the changes of vascular resistance between the second day after admission and the second day after operation.After 1 year follow-up,we assigned patients to two groups according to death.There was no difference in general data,blood test.There was no difference in systolic and diastolic blood pressure,heart rate,rate-pressure product and vascular resistance before and after insertion of intramedullary nail.There was no difference in their variations.In some patients,there was significance change in the vascular resistance before and after the insertion of intramedullary nail and the vascular resistance on the second day after admission is the risk factor.We didn’t find factor affecting outcome of patients.Conclusion:Insertion of nail has some effects on the cardiovascular system of elderly patients,but they are transient and can be restore.We should choose the operation carefully for the patients with high vascular resistance.PPG can be used for monitoring cardiovascular system during orthopedic surgery.