E-PASS评分预测胫骨平台骨折患者术后并发症和住院时间延长风险研究  

A study of E-PASS score to predict the risk of postoperative complications and prolonged hospital stay in patients with tibial plateau fractures

作　　者：王明星 李杰[1] 胡月 贾宇[2] 李琦 WANG Ming-xing;LI Jie;HU Yue;JIA Yu;LI Qi(Department of Orthopaedics,Beijing Chaoyang Hospital,Capital Medical University,Beijing,100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院骨科,北京100020 [2]首都医科大学附属北京朝阳医院护理部,北京100020

出　　处：《中国骨与关节杂志》2025年第4期360-365,共6页Chinese Journal of Bone and Joint

摘　　要：目的分析生理能力与手术应激评估(estimation of physiologic ability and surgical stress,E-PASS)系统与胫骨平台骨折(tibial plateau fracture,TPF)患者术后并发症和住院时间关系。方法选取我院2022年1月至2024年5月手术治疗的155例TPF患者。根据术前及术中临床资料计算E-PASS评分中术前风险评分(preoperative risk score,PRS)、手术应激评分(surgical stress score,SSS)和综合风险评分(comprehensive risk score,CRS)。术后并发症情况根据术后30天内有无并发症发生定义和分类。住院时间延长(prolonged length of stay,PLOS)按超过所有住院时间第75百分位数患者进行定义和分类。采用接收者操作特征(receiver operating characteristic,ROC)曲线分析变量预测术后并发症和PLOS准确性。采用多因素logistic回归模型分析术后并发症和PLOS的独立危险因素。结果29例(18.6%)患者出现术后并发症。39例(25.2%)患者PLOS。ROC曲线分析显示,PRS、SSS和CRS预测术后并发症的曲线下面积(area under the curve,AUC)分别为0.849(0.790~0.896)、0.614(0.545~0.679)和0.869(0.813~0.913);PRS、SSS和CRS预测PLOS的AUC分别为0.853(0.796~0.900)、0.611(0.539~0.680)和0.855(0.798~0.901)。多因素logistic回归分析结果显示:体质量指数(body mass index,BMI)、C反应蛋白(C-reactive protein,CRP)、PRS和CRS是TPF患者术后并发症的独立危险因素(P<0.05);白蛋白(albumin,Alb)、CRP、PRS和CRS是患者PLOS独立危险因素(P<0.05)。BMI、CRP和BMI+CRP+CRS的ROC曲线预测术后并发症的AUC分别为0.761(0.685~0.825)、0.686(0.606~0.758)和0.935(0.883~0.968);Alb、CRP和Alb+CRP+CRS的ROC曲线预测PLOS的AUC分别为0.816(0.745~0.873)、0.718(0.640~0.787)和0.906(0.849~0.947)。结论E-PASS评分能有效评估TPF患者手术风险,有助于为临床医护人员优化围术期诊疗方案。Objective To analyse the estimation of physiologic ability and surgical stress(E-PASS)system in relation to postoperative complications and length of hospital stay in patients with tibial plateau fractures(TPF).Methods 155 patients with TPF who were surgically treated between January 2022 and May 2024 in our hospital were selected.Preoperative Risk Score(PRS),Surgical Stress Score(SSS),and Composite Risk Score(CRS)of the E-PASS score were calculated based on preoperative and intraoperative clinical data.Postoperative complications were defined and categorised according to the presence or absence of complications within 30 d postoperatively.Prolonged length of stay(PLOS)was defined and classified by exceeding the 75th percentile of all patients with length of stay.Receiver operating characteristic(ROC)curve analysis variables were used to predict postoperative complications and PLOS accuracy.Independent risk factors for postoperative complications and PLOS were analysed using multifactorial logistic regression models.Results Postoperative complications occurred in 29(18.6%)patients.39(25.2%)patients had PLOS.ROC curve analysis showed that the area under the curve(AUC)for PRS,SSS and CRS predicting postoperative complications was 0.849(0.790-0.896),0.614(0.545-0.679)and 0.869(0.813-0.913),respectively;the AUCs of PRS,SSS and CRS for predicting PLOS were 0.853(0.796-0.900),0.611(0.539-0.680)and 0.855(0.798-0.901),respectively.The results of multifactorial logistic regression analysis showed that body mass index,C-reactive protein(CRP),PRS,and CRS were independent risk factors for postoperative complications in patients with TPF(P<0.05);albumin,CRP,PRS,and CRS were independent risk factors for PLOS in patients(P<0.05).The ROC curves of BMI,CRP,and BMI+CRP+CRS predicting postoperative complications were 0.761(0.685-0.825),0.686(0.606-0.758),and 0.935(0.883-0.968),respectively;and the ROC curves for Alb,CRP,and Alb+CRP+CRS predicting PLOS with AUCs of 0.816(0.745-0.873),0.718(0.640-0.787)and 0.906(0.849-0.947).Conclusi

关 键 词：胫骨骨折 手术后并发症 住院时间 

分 类 号：R683.4[医药卫生—骨科学]