Hongo Takashi, Naito Hiromichi, Fujiwara Toshifumi, Inaba Mototaka, Fujisaki Noritomo, Nakao Atsunori
Emergency Department Okayama Saiseikai General Hospital Okayama Japan.
Department of Emergency Critical Care, and Disaster Medicine Dentistry, and Pharmaceutical Sciences Okayama University Graduate School of Medicine Okayama Japan.
Acute Med Surg. 2020 Dec 20;7(1):e618. doi: 10.1002/ams2.618. eCollection 2020 Jan-Dec.
Femoral neck fractures in elderly patients needing oxygen therapy are often encountered in the emergency department. This single-center, retrospective, observational study aimed to examine the frequency, cause, and factors related to hypoxia in elderly patients with femoral neck fractures.
We analyzed data from 241 patients admitted to Okayama Saiseikai General Hospital (Okayama, Japan) from April 2016 to March 2019. Hypoxia was defined as PaO / FiO ratio under 300. The independent factors for hypoxia were determined by multiple logistic regression analysis.
There were 194 patients who met the study inclusion criteria, 148 in the non-hypoxia group and 46 in the hypoxia group. The hypoxia group included patients with pneumonia ( = 3), chronic obstructive pulmonary disease ( = 2), pulmonary edema ( = 1), and pulmonary embolization ( = 1). The cause of hypoxia was undetermined in 39 cases. However, occult fat embolism syndrome was suspected in 29 of these 39 cases based on Gurd and Wilson criteria after considering clinical examination results. Barthel indexes were significantly lower in the hypoxia group on discharge. Age (adjusted odds ratio [OR] 1.07; 95% confidence interval [CI], 1.00-1.14; = 0.038), D-dimer (adjusted OR 1.02; 95% CI, 1.00-1.03; = 0.005), and transtricuspid pressure gradient (adjusted OR 1.03; 95% CI, 1.00-1.07; = 0.015) were independently associated with the hypoxia.
We found that hypoxia, including undetermined hypoxia, was commonly encountered in the emergency department. Hypoxia in elderly patients with femoral neck fractures was associated with age, D-dimer, and transtricuspid pressure gradient and needs further investigation.
急诊科经常会遇到需要吸氧治疗的老年股骨颈骨折患者。本单中心、回顾性观察研究旨在探讨老年股骨颈骨折患者缺氧的发生率、原因及相关因素。
我们分析了2016年4月至2019年3月入住冈山济生会综合医院（日本冈山）的241例患者的数据。缺氧定义为动脉血氧分压/吸入氧分数值低于300。通过多因素logistic回归分析确定缺氧的独立因素。
有194例患者符合研究纳入标准，非缺氧组148例，缺氧组46例。缺氧组包括肺炎患者（3例）、慢性阻塞性肺疾病患者（2例）、肺水肿患者（1例）和肺栓塞患者（1例）。39例患者缺氧原因不明。然而，根据临床检查结果，在这39例患者中，有29例根据Gurd和Wilson标准怀疑存在隐匿性脂肪栓塞综合征。出院时缺氧组的巴氏指数显著较低。年龄（调整比值比[OR]1.07；95%置信区间[CI]，1.00 - 1.14；P = 0.038）、D - 二聚体（调整OR 1.02；95%CI，1.00 - 1.03；P = 0.005）和三尖瓣跨瓣压差（调整OR 1.03；95%CI，1.00 - 1.07；P = 0.015）与缺氧独立相关。
我们发现急诊科常见缺氧情况，包括原因不明的缺氧。老年股骨颈骨折患者的缺氧与年龄、D - 二聚体和三尖瓣跨瓣压差有关，需要进一步研究。
