入院及围术期红细胞分布宽度变化与老年髋部骨折预后的关系  

Relationship between red blood cell distribution width on admission and perioperative changes and prognosis in elderly hip fracture patients

作　　者：薛萌 鲁娴 王然 钟振宇 张月英 XUE Meng;LU Xian;WANG Ran;ZHONG Zhenyu;ZHANG Yueying(Department of Anesthesiology,Affiliated Hospital of Xuzhou Medical University,Xuzhou,Jiangsu 221000,China)

机构地区：[1]徐州医科大学附属医院麻醉科,江苏徐州221000

出　　处：《安徽医药》2024年第11期2245-2249,I0009,共6页Anhui Medical and Pharmaceutical Journal

摘　　要：目的探究入院及围术期红细胞分布宽度(RDW)变化与老年髋部骨折预后的关系。方法回顾性收集2018年1月至2020年3月在徐州医科大学附属医院行髋部骨折手术治疗的老年病人650例的病历资料,收集年龄、性别、身体质量指数(BMI)、查尔森合并症指数(CCI)、骨折类型、入院RDW以及围术期ΔRDW(术后最高RDW与入院RDW差值)等信息,通过LASSO回归与多因素Cox回归分析病人病死率相关的危险因素。结果650例病人根据排除标准剔除264例,最终纳入分析共386例。该队列中病人术后1年病死率为10.36%(40/386),2年病死率为16.06%(62/386),4年病死率为23.58%(91/386),随访期病死率为26.17%(101/386)。LASSO回归分析结果显示年龄、CCI、入院血红蛋白、白蛋白、RDW和ΔRDW这6个变量为影响老年髋部骨折手术病人病死率的特征变量;多因素Cox回归分析结果显示年龄75~<85岁[HR=2.17,95%CI:(1.27,3.73),P=0.004]、年龄≥85岁[HR=3.73,95%CI:(2.11,6.62),P<0.001]、CCI≥2分[HR=3.58,95%CI:(2.15,5.95),P<0.001]、入院RDW>13.55%[HR=1.61,95%CI:(1.07,2.41),P=0.022]及ΔRDW>0.89%[HR=3.10,95%CI:(2.00,4.79),P<0.001]是老年髋部骨折手术病人病死率的危险因素。结论年龄≥75岁、CCI≥2分、入院RDW>13.55%以及ΔRDW>0.89%是老年髋部骨折手术病人病死率的独立危险因素。Objective To investigate the relationship between red blood cell distribution width(RDW)on admission and perioperative changes and prognosis in elderly hip fracture patients.Methods The medical records of elderly patients who underwent surgical treatment of hip fracture at the Affiliated Hospital of Xuzhou Medical University from January 2018 to March 2020 were retrospectively collected,and information such as age,gender,body mass index(BMI),Charlson comorbidity index(CCI),type of fracture,admission RDW,and perioperativeΔRDW(the highest postoperative RDW and admission RDW difference)were collected.The risk factors associated with patient mortality were analyzed by LASSO regression and multivariate Cox regression.Results Of the 650 patients,264 were excluded according to exclusion criteria,and a total of 386 patients were finally included in the analysis.Patients in this cohort had a 1-year postoperative mortality rate of 10.36%(40/386),a 2-year mortality rate of 16.06%(62/386),a 4-year mortality rate of 23.58%(91/386),and a follow-up mortality rate of 26.17%(101/386).LASSO regression analysis showed that age,CCI,admission hemoglobin,albumin,RDW,andΔRDW,the six variables,were the characteristic variables affecting mortality in elderly patients undergoing hip fracture surgery;the results of the multivariate Cox regression analysis showed age 75-<85[HR=2.17,95%CI:(1.27,3.73),P=0.004],age≥85[HR=3.73,95%CI:(2.11,6.62),P<0.00],CCI≥2[HR=3.58,95%CI:(2.15,5.95),P<0.001],admission RDW>13.55%[HR=1.61,95%CI:(1.07,2.41),P=0.022],andΔRDW>0.89%[HR=3.10,95%CI:(2.00,4.79),P<0.001]were risk factors for mortality in elderly patients undergoing hip fracture surgery.Conclusion Age≥75 years,CCI≥2 points,admission RDW>13.55%,andΔRDW>0.89%are independent risk factors for mortality in elderly patients undergoing hip fracture surgery.

关 键 词：髋骨折 老年病人 手术 红细胞分布宽度 预后 

分 类 号：R687.3[医药卫生—骨科学]