重症监护室内老年髋部骨折术后患者休克风险的多因素分析及模型构建  

Multivariate analysis and model construction of shock risk in elderly patients with hip fracture after operation in intensive care unit

作　　者：白颖[1] 于淼淼 金丽鲜 李智敏 李华杰 孔月月 周宁[1] Bai Ying;Yu Miao-miao;Jin Li-xian;Li Zhi-min;Li Hua-jie;Kong Yue-yue;Zhou Ning(Department of Critical Care Medicine,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京积水潭医院重症医学科,北京100035

出　　处：《中国急救医学》2023年第6期445-450,共6页Chinese Journal of Critical Care Medicine

基　　金：北京市属医院科研培育计划(PX2022014)。

摘　　要：目的筛选老年髋部骨折术后患者休克指数(SI)升高的危险因素并建立预测模型。方法收集2022年1月至2023年1月在北京积水潭医院行髋部骨折手术且术后进入ICU老年患者数据。观察患者基本情况、术前实验室指标和术中情况。采用Logistic单因素回归分析休克相关危险因素,通过多因素分析筛选休克独立危险因素。开发预测模型并绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC)并评估预测模型效能。结果共纳入187例老年髋部骨折患者,休克组29例,非休克组158例,术后休克发生率为18.4%。两组患者的骨折类型、术前血磷、术前血肌酐差异有统计学意义(P<0.05)。Logistic单因素分析显示,骨折类型、术前血磷是老年髋部骨折术后休克的危险因素。多因素分析显示,骨折类型、术前血磷≤1 mmol/L、查尔森合并症指数(Charlson comorbidity index,CCI)评分≥5分为独立危险因素。建立模型及ROC曲线,AUC为0.742(95%CI 0.651~0.833),敏感度为62.1%,特异度为71.5%。Hosmer-Lemeshow拟合优度检验χ^(2)=2.284,P=0.391。结论股骨转子间骨折、术前血磷≤1 mmol/L、CCI评分≥5分为老年髋部骨折术后SI升高的独立危险因素;通过建立预测模型,为术后筛选高风险患者提供了重要的临床工具。Objective To analyze the clinical characteristics and screen the risk factors of increased shock index(SI)in elderly patients with hip fracture after operation,and to establish a prediction model.Methods The data of elderly patients who underwent hip fracture surgery in Beijing Jishuitan Hospital from January 2022 to January 2023 and entered ICU monitoring after surgery were collected.The patient′s basic condition,preoperative laboratory indicators and intraoperative condition were observed.Logistic univariate regression was used to analyze the shock-related risk factors,and multivariate analysis was used to screen the independent risk factors.The prediction model was established,and the receiver operating characteristic(ROC)curve was plotted to evaluate the model efficiency.Results A total of 187 patients were included,29 in the shock group and 158 in the non-shock group.The incidence of postoperative shock was 18.4%.There were significant differences in fracture type,preoperative blood phosphorus and preoperative creatinine between the two groups(P<0.05).Logistic univariate analysis showed that fracture type and preoperative blood phosphorus were risk factors for postoperative shock in elderly patients with hip fracture.Multivariate analysis showed that fracture type,preoperative blood phosphorus≤1 mmol/L,and Charlson comorbidity index(CCI)≥5 were independent risk factors.The area under the ROC curve(AUC)was 0.742(95%CI 0.651-0.833),the sensitivity was 62.1%,and the specificity was 71.5%.Hosmer-Lemeshow goodness of fit test showedχ^(2)=2.284,P=0.391.Conclusions Intertrochanteric fracture,preoperative blood phosphorus≤1 mmol/L,and CCI≥5 were independent risk factors for the increase of SI in elderly patients with hip fracture after operation.Through the establishment of prediction model,it provides a clinically important tool for screening high-risk patients after surgery.

关 键 词：髋部骨折 术后休克 休克指数(SI) 查尔森合并症指数(CCI) 危险因素 预测模型 

分 类 号：R687.3[医药卫生—骨科学]