摘要
[目的]分析老年转子间骨折术后输血的危险因素,建立预测模型并对其验证。[方法]回顾性分析本院2016年12月—2021年12月收治的老年转子间按骨折共358例患者临床资料。按术后是否输血,分为输血组和非输血组,采用单因素和多因素分析得出术后输血的危险因素。建立预测模型,对模型效能进行评定。[结果]358例患者中,共168例术后输血,占46.9%。单项因素比较显示,输血组患者较非输血组年龄更大[(80.7±8.5)岁vs(76.6±8.7)岁,P<0.001]、BMI更小[(20.7±3.3)kg/m^(2)vs(21.5±3.7)kg/m^(2),P=0.015]、高血压占比更高[(105/63)vs(93/97),P=0.010]、骨折类型更严重[A1/A2/A3,(40/93/35)vs(80/83/27),P<0.001]、手术时间更长[(122.9±56.6)min vs(101.4±30.5)min,P<0.001]、术中出血量更多[(258.3±218.9)ml vs(130.5±94.9)ml,P<0.001]、术前HB更低[(93.1±14.8)g/L vs(111.6±14.2)g/L,P<0.001]、术前Alb更低[(34.7±8.2)g/L vs(36.8±4.5)g/L,P=0.002],差异均有统计学意义。逻辑回归分析显示:年龄(OR=1.053,P=0.007)、手术时间(OR=1.008,P=0.025)、术中出血量(OR=1.007,P<0.001)是术后输血发生的独立危险因素;而BMI(OR=0.900,P=0.025)和术前血红蛋白(OR=0.904,P<0.001)是术后输血的独立保护因素。基于逻辑回归结果所得的术后输血预测方程曲线下面积AUC为0.894,95%CI 0.862~0.927,最佳临界值为0.578,敏感度为74.4%,特异度为88.4%。[结论]高龄、手术时间长、术中出血多、低BMI和低血红蛋白是术后发生输血的独立危险因素。术后输血预测模型有助于临床判断输血发生风险并提前预防。
[Objective]To analyze the risk factors of postoperative blood transfusion of femoral intertrochanteric fracture in the elderly,and an established prediction equation was verified.[Methods]A retrospective study was done on 358 elderly patients who received surgical treatment for femoral intertrochanteric fractures in our hospital from December 2016 to December 2021.The patients were divided into transfusion group and non-transfusion group according to whether postoperative blood transfusion occurred.The univariate comparisons and multi-factor binary logistic regression analysis were conducted to search the relative factors,and then a prediction model was established with its efficiency evaluated.[Results]Among the 358 patients,168(46.9%)received postoperative blood transfusion.In term of univariate comparison,the transfusion group were significantly older in age[(80.7±8.5)years vs(76.6±8.7)years,P<0.001],lower BMI[(20.7±3.3)kg/m^(2)vs(21.5±3.7)kg/m^(2),P=0.015],higher prevalence of hypertension[(105/63)vs(93/97),P=0.010],and more severe fracture types[A1/A2/A3,(40/93/35)vs(80/83/27),P<0.001],longer operation time[(122.9±56.6)min vs(101.4±30.5)min,P<0.001],more intraoperative blood loss[(258.3±218.9)ml vs(130.5±94.9)ml,P<0.001],lower preoperative Hb[(93.1±14.8)g/L vs(111.6±14.2)g/L,P<0.001],and lower preoperative Alb[(34.7±8.2)g/L vs(36.8±4.5)g/L,P=0.002]than the non-transfusion group,and all abovesaid were statistically significant between the two groups.As results of logistic regression analysis,the age(OR=1.053,P=0.007),operation time(OR=1.008,P=0.025),intraoperative blood loss(OR=1.007,P<0.001)were the independent risk factors for postoperative transfusion,while the BMI(OR=0.900,P=0.025)and preoperative hemoglobin(OR=0.904,P<0.001)were the independent protective factor.Based on the logistic regression results,a prediction equation was established,which proved area under curve(AUC)of 0.894,95%CI 0.862~0.927,with cutoff of0.578,the sensitivity of 74.4%,and the specificity of 88.4%by the ROC analysis.[
作者
王卓
刘序强
陈延朕
钟元武
李晓峰
戴闽
聂涛
WANG Zhuo;LIU Xu-qiang;CHEN Yan-zhen;ZHONG Yuan-wu;LI Xiao-feng;DAI Min;NIE Tao(Department of Orthopedics,The First Affiliated Hospital,Nanchang University,Nanchang330000,China)
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2024年第2期104-108,共5页
Orthopedic Journal of China
基金
省卫健委科技计划项目(编号:202130235)
省中医药科技计划项目(编号:2021Z020)。
关键词
老年人
股骨转子间骨折
术后输血
相关因素
预测
elderly
femoral intertrochanteric fracture
postoperative blood transfusion
related factors
prediction
