摘要
目的探讨高龄髋部骨折患者术后发生肺炎的相关危险因素,并评估这些因素对术后肺炎的预测价值。方法回顾性分析2012年1月至2021年12月期间深圳市第二人民医院骨关节科采用手术治疗的617例年龄≥80岁的髋部骨折患者资料。男173例,女444例;年龄(85.8±4.5)岁;股骨颈骨折331例,股骨转子间骨折286例。按住院期间术后24 h后是否发生肺炎将患者分为肺炎组和无肺炎组,比较两组患者的基本信息、合并基础疾病、术前实验室检查指标、术中相关变量及术后入住重症监护病房(ICU)等的差异。将两组患者之间比较P<0.05的项目纳入二元logistic回归分析,确定术后肺炎的危险因素。采用受试者工作特征曲线(ROC)评估危险因素的预测效能。结果617例患者中,9.6%(59/617)的患者术后确诊为肺炎。二元logistic回归分析结果显示:高龄(OR=1.089,95%CI:1.029~1.154,P=0.003)、高中性粒细胞/淋巴细胞比值(NLR)(OR=1.073,95%CI:1.031~1.117,P=0.001)、低血红蛋白(OR=0.979,95%CI:0.965~0.995,P=0.008)、高球蛋白(OR=1.111,95%CI:1.053~1.172,P<0.001)、合并冠状动脉粥样硬化性心脏病(CHD)(OR=2.691,95%CI:1.353~5.351,P=0.005)及入住ICU(OR=9.732,95%CI:3.527~26.855,P<0.001)是高龄髋部骨折患者术后发生肺炎的危险因素。列线图相关ROC的曲线下面积为0.779(95%CI:0.715~0.843)。结论高龄髋部骨折患者术后肺炎的发生与年龄、NLR、球蛋白、合并CHD、入住ICU呈正相关,与血红蛋白呈负相关。本研究筛选出的危险因素具有中等预测效能,可为临床早期识别高风险患者提供量化工具。
Objective To investigate the risk factors associated with postoperative hospital-acquired pneumonia occurring in elderly patients(age≥80)with hip fracture and their predictive value for postoperative pneumonia.Methods A retrospective study was conducted to analyze the 617 patients aged≥80 years who had undergone surgery for hip fractures at Department of Orthopedics and Joint Surgery,The Second People's Hospital of Shenzhen between January 2012 and December 2021.The cohort included 173 males and 444 females,with an age of(85.8±4.5)years.There were 331 femoral neck fractures and 286 intertrochanteric fractures.Based on the hospital-acquired pneumonia occurring more than 24 hours after surgery,the patients were divided into a pneumonia group and a pneumonia-free group.The differences were compared between the 2 groups in basic information,comorbidities,preoperative laboratory examination indicators,related intraoperative variables,and postoperative admission to intensive care unit(ICU).The items with P<0.05 between the 2 groups were analyzed by binary logistic regression to determine the risk factors for postoperative pneumonia.Receiver operating characteristic(ROC)curve analysis was used to evaluate the predictive value of the risk factors.ResultsOf the 617 elderly patients with hip fracture,59(9.6%)were diagnosed with postoperative pneumonia.Binary logistic regression analysis identified the following independent risk factors for postoperative pneumonia:advanced age(OR=1.089,95%CI:1.029 to 1.154,P=0.003),elevated neutrophil/lymphocyte ratio(NLR)(OR=1.073,95%CI:1.031 to 1.117,P=0.001),decreased hemoglobin(OR=0.979,95%CI:0.965 to 0.995,P=0.008),elevated globulin(OR=1.111,95%CI:1.053 to 1.172,P<0.001),pre-existing coronary atherosclerotic heart disease(CHD)(OR=2.691,95%CI:1.353 to 5.351,P=0.005),and admission to ICU(OR=9.732,95%CI:3.527 to 26.855,P<0.001).After a predictive nomogram was constructed based on the above risk factors for postoperative pneumonia,its area under the ROC curve was 0.779(95%CI:0.715 to 0.843).Conclusions Occurrence of postoperative pneumonia in elderly patients with hip fracture is positively related to age,NLR,globulin,pre-existing CHD,and admission to ICU,while negatively related to hemoglobin.Since the risk factors identified in this study have a moderate predictive power,they can serve as a quantitative tool for early identification of high-risk patients in clinical practice.
作者
孙丽鑫
李嘉琛
孙炜
李伟
王满宜
何琦非
Sun Lixin;Li Jiachen;Sun Wei;Li Wei;Wang Manyi;He Qifei(Department of Orthopedics and Joint Surgery,The Second People's Hospital of Shenzhen,Shenzhen 518000,China)
出处
《中华创伤骨科杂志》
北大核心
2025年第12期1081-1086,共6页
Chinese Journal of Orthopaedic Trauma
基金
广东省医学科研基金(A2025217)
深圳市科技创新委员会可持续发展专项项目(KCXFZ20230731093059012)
深圳市博士后来深资助项目(1040012)
深圳市第二人民医院院级临床研究重点项目(20243357007)
深圳市第二人民医院院级临床研究项目(20253357006)。
