만성 신질환 환자에서 발생한 고관절부 골절의 수술 후 합병증
Postoperative Complications of Hip Fractures in Patients with Chronic Kidney Disease
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목적: 만성 신질환 환자에서 고관절부 골절의 수술 후 합병증 발생과 사망률에 영향을 미치는 인 자를 분석하고자 하였다. 대상 및 방법: 2001년 02월부터 2007년 02월까지 만성 신질환 환자 중 고관절부 골절로 수술적 치료를 받았던 59예를 대상으로 하였다. 평균 연령은 72(45~83)세였고, 남자가 21예, 여자가 38예였다. 대퇴골 경부 골절은 14예, 대퇴골 전자간 골절은 45예이었다. 연령, 성별, 기존질환, 골밀도, 수술 전 폐기능 검사, 수술 시기, 수술 방법, 마취 위험도에 따른 미국마취과 학회 분류, 추정 사구체 여과율 등에 따른 수술 후 합병증과 사망률을 분석하였다. 결과: 만성 신질환을 가진 59명의 환자에서 수술 후 합병증은 35.9%, 사망률은 15.3% 이었다. 수술 전 낮은 폐기능은 수술 후 사망률을 증가시켰으며, 수술 시기, 미국마취과 학회 분류 등이 수술 후 합병증과 사망률에 영향을 주었다. 결론: 만성 신질환 환자에서 고관절부 골절의 수술 후 합병증은 호흡기 계통의 질환이 많이 발생 하였고, 사망의 원인은 폐렴과 패혈증에 의한 경우가 많았으므로 감염에 주의를 요한다.
Abstract
Purpose: The purpose of the present study was to evaluate the factors affecting the complications and the mortality rate after surgery for hip fractures in patients with chronic kidney disease. Materials and Methods: We retrospectively analyzed 59 patients with chronic kidney disease and who were managed with surgical treatment after hip fracture between February 2001 and February 2007. The average age was 72 (range: 45~83) years old. There were 21 men and 38 women. The postoperative complications and mortality rate were analyzed according to the patients’ age and gender, the comorbid medical diseases, the preoperative pulmonary function tests, the timing of the operation and the operation methods, the American Association of Anesthetists score and the estimated glomerular filtration ratio (eGFR). Results: For 59 patients with chronic kidney disease, the overall complication rate was 35.9% and the mortality rate was 15.3%. The patients with poor pulmonary function showed a high mortality rate in the postoperative period. The timing of the operation and the ASA score were associated with the postoperative complications rate and the mortality rate. Conclusion: Respiratory complications were dominant in the hip fracture patients with chronic kidney disease. The cause of death was mainly associated with pneumonia and a septic condition. Careful management must be done during the postoperative period to prevent infectious complications.
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