老年人髋部手术术后早期预后不佳的炎症因子变化和危险因素分析  

Changes of inflammatory factors and risk factors of poor short-term prognosis after hip surgery in the elderly

作　　者：吴良优 曾胜湖 钟玲 WU Liang-you;ZENG Sheng-hu;ZHONG Ling(Department of Anesthesia,First Department of Orthopaedics,Heyuan 517000,Guangdong,CHINA;Department of Acupuncture and Rehabilitation,Heyuan 517000,Guangdong,CHINA;Department of Heyuan Hospital of Traditional Chinese Medicine,Heyuan 517000,Guangdong,CHINA)

机构地区：[1]河源市中医院手术麻醉科,广东河源517000 [2]河源市中医院骨伤科一区,广东河源517000 [3]河源市中医院针灸康复科,广东河源517000

出　　处：《海南医学》2025年第4期488-492,共5页Hainan Medical Journal

基　　金：广东省河源市科技计划项目(编号:240523151602773)。

摘　　要：目的分析老年人髋部手术术后早期预后不佳的炎症因子变化和危险因素。方法回顾性分析2021年1月至2024年7月河源市中医院收治的100例老年髋部手术患者的临床资料,按照住院期间患者的不同预后分为早期预后不佳组12例与早期预后良好组88例。比较两组患者术后3 d的炎症因子水平[中性粒细胞/淋巴细胞比值(NLR)、C反应蛋白/白蛋白比值(CAR)],采用受试者工作特征(ROC)曲线分析各项指标对老年髋部术后早期预后不佳的预测价值;比较两组患者的临床资料,采用COX多因素回归分析老年髋部术后早期预后不佳的危险因素。结果早期预后不佳组患者的NLR、CAR水平分别为14.45±2.59、2.74±0.45,明显高于早期预后良好组的9.19±1.37、1.51±0.26,差异均有统计学意义(P<0.05);ROC分析结果显示,NLR、CAR及联合检测对老年髋部骨折术后早期预后不佳预测的曲线下面积(AUC)分别为0.756、0.745、0.815。早期预后不佳组患者的年龄>75岁、ASAⅢ~Ⅳ级、内科基础疾病>2种、低蛋白血症率、贫血率、全身麻醉率、未进行超前镇痛率分别为66.67%、41.67%、66.67%、41.67%、33.33%、75.00%、75.00%,明显高于短期预后良好组的17.05%、13.64%、17.05%、10.23%、10.23%、11.36%、20.45%,差异均有统计学意义(P<0.05);COX多因素回归分析结果显示,高NLR、高CAR、高龄、内科基础疾病>2种、低蛋白血症、全身麻醉、未行超前镇痛均是术后早期预后不佳的危险因素(P<0.05)。结论老年髋部手术术后早期预后不佳与炎症因子上升有一定关系,且和多种危险因素有关,临床重视此类患者危险因素的干预,利于预后改善。Objective To analyze the changes of inflammatory factors and risk factors of poor short-term prognosis after hip surgery in the elderly.Methods The clinical data of 100 elderly patients with hip surgery admitted to Heyuan Hospital of Traditional Chinese Medicine from January 2021 to July 2024 were retrospectively analyzed.They were divided into the poor short-term prognosis group(12 cases)and the good short-term prognosis group(88 cases)according to the different prognoses during hospitalization.The levels of inflammatory factors(neutrophil/lymphocyte ratio[NLR],C-reactive protein/albumin ratio[CAR])of the two groups were compared at 3 days after surgery.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of each indicator for the poor short-term prognosis after hip surgery in the elderly.The clinical data of the two groups were compared,and COX multifactor regression was used to analyze the risk factors of poor short-term prognosis after hip surgery in the elderly.Results The levels of NLR and CAR in the poor short-term prognosis group were 14.45±2.59 and 2.74±0.45,which were significantly higher than 9.19±1.37 and 1.51±0.26 in the good short-term prognosis group(P<0.05).ROC curve showed that the area under the curve(AUC)of NLR,CAR,and combined detection was 0.756,0.745,and 0.815,respectively.The proportions of patients with age>75,ASAⅢ-Ⅳgrade,>2 kinds of basic medical diseases,hypoproteinemia,anemia,general anesthesia,and no preanalgesia in the poor short-term prognosis group were 66.67%,41.67%,66.67%,41.67%,33.33%,75.00%,and 75.00%,which were significantly higher than 17.05%,13.64%,17.05%,10.23%,10.23%,11.36%,and 20.45%in the good short-term prognosis group(P<0.05).COX multivariate regression analysis showed that high NLR,high CAR,old age,>2 kinds of basic medical diseases,hypoproteinemia,general anesthesia,and no pre-analgesia were the risk factors for poor short-term prognosis after surgery(P<0.05).Conclusion The poor short-term prognosis of elderly patients after hip

关 键 词：老年 髋部手术 预后 炎症因子 危险因素 

分 类 号：R681.6[医药卫生—骨科学]