| The study on excess mortality of elderly hip fracture is Scarcely in china. Becausedifferent population is an important factor that affects death risk and mortality, there isan important significance for us to do research about excess mortality following hipfracture in elderly people in specific region of china. Elderly hip fracture triggersexcessive systemic inflammatory response sydrome (SIRS), which is an independentrisk factor of high mortality after hip fracture.In the early post-traumatic, we assumeto give patients anti-inflammatory drug that will reduce the systemic inflammatoryresponse, diminish the extent damage of organ, improve prognosis.Part I: Analyze of excess mortality following hip fracture in elderly using dataprovided by Beijing Medicare Library.Objective: Collect data from the Beijing Medicare Library and analyze excessivemortality risk following hip fracture in elderly people of Beijing, then furtherconclude its characteristics.Methods: We checked the Beijing Medicare database from January2008toDecember2011and collected the treatment information of patients with elderly hipfracture including the1-year survival information of all ages and different gendergroups. Then,compare the mortality of patients who have experienced hip fracturewith corresponding overall mortality of people without fracture.Finally, analyze theexcess mottality created created by hip fracture and its characteristics.Results: From the database,we conclude that the incidence rate of hip fracture in thesenior citizen of Beijing is0.27%and the mortality after fracture is23.44%in1year,.The excess mortality rate of male and female in60~69years old and70~79years oldand over80years old ages respectively is4.02%,15.33%,14.01%and5.42%,7.28%and5.47%, and the odds ratio (OR) respectively is2.234(95%CI1.432~3.487), 2.988(95%CI2.569~3.499),1.900(95%CI1.641~2.224) and3.123(95%CI2.037~4.787),1.929(95%CI1.638~2.272),1.358(95%CI1.207~1.547). Thecomplications of lung accountes for52.27%in the causes of death.Conclusions: Older people in Beijing who experience a hip fracture have a twofoldexcessive mortality risk in the first year after the fracture. The risk was highest amongpatients of ages between70and79. Over70years old, the mortality and the excessmortality risk of male were significantly higher than female. The major cause of deathis lung infection.Part II: clinical observation on the results of anti-inflammation treatment usingCOX-2inhibitor to improve prognosisObjective: Design prospective stochastic comparison clinical study and reseach thetherapeutic effect of COX-2inhibitors in reducing the systemic inflammatoryresponse after elderly hip fracture and of improving prognosis in the elderly.Methods: Collect133senile hip fracture cases from December2011to September2012and patients were randomly assigned to two groups. The experimental groupwas given celecoxib while control group was given paracetamol and oxycodone.During hospitalization we detect inflammatory cytokines (IL-6, IL-10, TNF-α, PGE2)concentration in peripheral blood. The patients were followed up within1year andcollected the informations of survival, complication, fracture healing and functionalrecovery.Results: The various inflammation cytokines levels markedly reduces in experimentalgroup compared to control group, their fluctuation become more gentlely. The averagelength of hospitalization was significantly shorter (P=0.0049) in experimental groupthan the control group. Survival rate of experimental group was slightly better butthere is no significant difference.It also has no significant difference in complications,recovery of activity of daily living and fracture healing.Conclusion: Anti-inflammatory treatment with COX-2inhibitor can reduce thesystemic inflammatory response, shorten LOS and has trend to improve survival ratesof the elderly hip fracture patients. |
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