营养状态评估对老年髋部骨折患者术后谵妄风险的预测价值  

Predictive value of nutritional status assessment for postoperative delirium risk in elderly patients with hip fracture

作　　者：郭晓慧 马燕利 张欢[1] 王晓宇[1] 胡健[1] 张培海[2] 许平平 GUO Xiaohui;MA Yanli;ZHANG Huan;WANG Xiaoyu;HU Jian;ZHANG Peihai;XU Pingping(Department of Anesthesiology,Beijing Tsinghua Changgung Hospital,Clinical Medical College of Tsinghua University,Beijing,102300;Department of Neurosurgery,Beijing Tsinghua Changgung Hospital,Clinical Medical College of Tsinghua University,Beijing,102300;Department of Orthopedics,Beijing Tsinghua Changgung Hospital,Clinical Medical College of Tsinghua University,Beijing,102300)

机构地区：[1]清华大学附属北京清华长庚医院/清华大学临床医学院麻醉科,北京102300 [2]清华大学附属北京清华长庚医院/清华大学临床医学院神经外科,北京102300 [3]清华大学附属北京清华长庚医院/清华大学临床医学院骨科,北京102300

出　　处：《实用临床医药杂志》2024年第11期94-98,共5页Journal of Clinical Medicine in Practice

基　　金：北京清华长庚医院青年启动基金资助项目(12021c1015)。

摘　　要：目的探讨营养状态评估对老年髋部骨折患者术后谵妄(POD)风险的预测价值。方法选取114例老年髋部骨折患者作为研究对象,根据是否发生POD分为谵妄组43例和非谵妄组71例。收集2组患者的一般资料、实验室指标和老年营养风险指数(GNRI)、预后营养指数(PNI)、控制营养状态(CONUT)评分。采用多因素Logistic回归分析探讨POD发生的独立影响因素,绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),分析各独立影响因素对POD发生风险的预测价值。结果谵妄组糖尿病患者占比高于非谵妄组,空腹血糖、CONUT评分高于非谵妄组,GNRI、PNI低于非谵妄组,差异有统计学意义(P<0.05);多因素Logistic回归分析结果显示,血糖、GNRI、PNI、CONUT评分是POD发生的独立影响因素(P<0.05);ROC曲线分析结果显示,血糖、GNRI、PNI、CONUT评分单独预测POD发生风险的AUC分别为0.610、0.780、0.821、0.749,小于四者联合预测的AUC(0.897)。结论血糖、GNRI、PNI、CONUT评分均为老年髋部骨折患者发生POD的独立影响因素,四者联用对POD发生风险具有较好的预测价值。Objective To investigate the predictive value of nutritional status assessment for postoperative delirium(POD)risk in elderly patients with hip fracture.Methods A total of 114 elderly patients with hip fracture were selected as study subjects.According to the occurrence of POD,they were divided into delirium group(43 cases)and non-delirium group(71 cases).General information,laboratory indicators,geriatric nutritional risk index(GNRI),prognostic nutritional index(PNI),and controlling nutritional status(CONUT)scores were collected for the two groups.Multivariate Logistic regression analysis was used to explore the independent influencing factors of POD occurrence.Receiver operating characteristic(ROC)curves were plotted,and the area under the curves(AUC)were calculated to analyze the predictive value of each independent influencing factor for POD risk.Results The proportion of diabetic patients,fasting blood glucose and CONUT scores in the delirium group were higher,but GNRI and PNI were lower than that in the non-delirium group(P<0.05).Multivariate Logistic regression analysis showed that blood glucose,GNRI,PNI,and CONUT scores were independent influencing factors for POD occurrence(P<0.05).ROC curve analysis revealed that the AUC s of blood glucose,GNRI,PNI,and CONUT scores alone in predicting POD risk were 0.610,0.780,0.821,and 0.749,respectively,which were lower than the AUC(0.897)when the four factors were combined.Conclusion Blood glucose,GNRI,PNI,and CONUT scores are independent influencing factors for POD occurrence in elderly patients with hip fracture.The combined use of these four factors has good predictive value for POD risk.

关 键 词：营养状态 老年 髋部骨折 谵妄 老年营养风险指数 预后营养指数 控制营养状态评分 

分 类 号：R683[医药卫生—骨科学] R619[医药卫生—外科学] R151.1[医药卫生—临床医学]