围手术期营养风险与髋部骨折患者静脉血栓栓塞症的关系  

Relationship between perioperative nutrition risk and venous thromboembolism in patients with hip fracture

作　　者：何苗[1] 彭容[2] 田金山 刘璇 邓磊[1] 吴茜 HE Miao;PENG Rong;TIAN Jinshan;LIU Xuan;DENG Lei;WU Qian(Department of Anesthesiology,Affiliated Hospital of Chengdu University,Chengdu 610081,China;Department of Clinical Nutrition,Affiliated Hospital of Chengdu University,Chengdu 610081,China;Department of Orthopedics,Affiliated Hospital of Chengdu University,Chengdu 610081,China;Drug Clinical Trial Center,Affiliated Hospital of Chengdu University,Chengdu 610081,China)

机构地区：[1]成都大学附属医院麻醉科,610081 [2]成都大学附属医院临床营养科,610081 [3]成都大学附属医院骨科,610081 [4]成都大学附属医院药物临床试验中心,610081

出　　处：《天津医药》2024年第1期97-101,共5页Tianjin Medical Journal

基　　金：成都市卫生健康委员会医学科研项目(2020134);四川省医疗卫生与健康促进会省级科研项目(KY2022SJ0044);四川省医学会静脉血栓栓塞症专项课题(2019HR50)。

摘　　要：目的探讨围手术期营养风险与髋部骨折患者静脉血栓栓塞症(VTE)的关系。方法选取因摔伤或扭伤导致单侧髋部骨折择期行外科手术患者379例,根据围手术期是否发生VTE分为非VTE组(246例)和VTE组(133例),收集2组患者的基本信息、手术和麻醉记录、营养风险相关指标和炎症指标;采用多因素Logistic回归分析围手术期VTE的独立影响因素;受试者工作特征(ROC)曲线评估独立因素的鉴别能力,并用DeLong检验比较曲线下面积(AUC)。结果与非VTE组比较,VTE组年龄偏大,合并高血压、就诊时间>2 d、接受(空心/髓内钉)内固定手术、围手术期输血和美国麻醉医师协会(ASA)Ⅲ—Ⅳ级患者比例,入院时NRS(营养风险筛查表)-2002评分和术后中性粒细胞/淋巴细胞比值(NLR)更高;入院时和术后预后营养指数(PNI)、血红蛋白(Hb),入院时前白蛋白(PA)均低于非VTE组(P<0.01);多因素Logistic回归分析显示,患者行内固定术,入院时PNI降低,NRS-2002评分和PA升高,就诊时间>2 d,ASAⅢ—Ⅳ级是髋部骨折围手术期发生VTE的独立危险因素(P<0.05)。ROC曲线分析显示,入院时NRS-2002的AUC(95%CI)为0.739(0.692~0.783),入院时PNI的AUC(95%CI)为0.720(0.672~0.765),两者的预测价值优于其他影响因素(P<0.01)。结论髋部骨折患者入院时NRS-2002和PNI对围手术期VTE具有一定的预测价值。Objective To investigate the relationship between perioperative nutritional risk and venous thromboembolism(VTE)in patients with hip fracture.Methods A total of 379 patients with unilateral hip fracture due to fall or sprain who underwent elective surgery were selected and divided into the non-VTE group(246 cases)and the VTE group(133 cases)according to whether or not VTE occurred during perioperative period.Basic information,surgical and anesthesia records,nutritional risk related indicators,inflammatory indicators and outcome indicators of patients were collected.Multiple Logistic regression was used to analyze the independent influencing factors of perioperative VTE.Receiver operating characteristics(ROC)curves were used to assess the ability to discriminate independent factors,and DeLong test was used to compare area under the curve(AUC).Results Compared with the non-VTE group,the proportion of patients in the VTE group was older,complicated with hypertension,the time to visit hospital more than 2 days,received(hollow/intramedullary nail)internal fixation,perioperative blood transfusion,ASA gradeⅢtoⅣ,and higher nutritional risk screening Table(NRS)-2002 scores on admission and higher postoperative neutrophil/lymphocyte ratio(NLR).Nutritional prognosis index(PNI),hemoglobin(Hb)and prealbumin(PA)at admission and after operation were lower in the VTE group than those in the non-VTE group(P<0.01).Multivariate Logistic regression analysis showed that PNI was decreased,NRS-2002 scores and PA were increased,and the time of visit hospital was>2 days after internal fixation.American College of Anesthesiologists(ASA)gradesⅢ-Ⅳwere independent risk factors for perioperative VTE of hip fracture(P<0.05).ROC curve analysis showed that the AUC(95%CI)of NRS-2002 at admission was 0.739(0.692-0.783),and that of PNI at admission was 0.720(0.672-0.765),both of which were better than other influencing factors(P<0.01).Conclusion NRS-2002 and PNI are good predictors of perioperative VTE in patients with hip fracture.

关 键 词：静脉血栓栓塞 髋骨折 围手术期 营养风险筛查表-2002 预后营养指数 

分 类 号：R614[医药卫生—麻醉学] R151[医药卫生—外科学]