摘要
目的研究老年髋部骨折既往脑卒中患者术后90 d不良结局的危险因素,并绘制列线图预测风险。方法回顾性分析2017年3月至2024年9月于上海交通大学附属第六人民医院手术治疗的602例既往诊断脑卒中的老年髋部骨折患者,记录患者基本资料、基础合并症、既往脑卒中时间、术前并发症、美国麻醉医师协会(ASA)分级、年龄校正查尔森合并症指数(aCCI)评分、改良Rankin量表(mRS)评分等,随访术后90 d内发生死亡和严重并发症等不良结局,分析其独立影响因素并使用R语言rms程序包构建风险预测列线图模型。结果共78例患者发生不良结局(12.95%),股骨粗隆间骨折、心功能不全、肺部/尿路感染、低蛋白血症、电解质紊乱及mRS评分>2分是患者术后90 d内不良结局的独立危险因素[OR(95%CI)分别为5.259(2.767~9.995)、4.206(1.798~9.836)、3.759(1.904~7.422)、2.269(1.239~4.154)、1.951(1.055~3.606)、3.130(2.404~4.074)]。基于以上6个因素构建列线图并进行内部验证,结果模型一致性指数(C-index)=0.901(95%CI 0.868~0.934),预测曲线与实际数值基本吻合,模型预测效果好。结论股骨粗隆间骨折、心功能不全、术前肺部/尿路感染、低蛋白血症、电解质紊乱及mRS评分>2分是老年髋部骨折既往脑卒中患者术后90 d不良结局的独立危险因素,以此构建的列线图模型对预测该类患者术后90 d不良结局有较好的价值。
Objective To study the risk factors of adverse outcomes in elderly hip fracture patients with previous stroke history during the 90-day postoperative period and to make a nomogram to predict the risk of adverse outcomes occurrence.Methods A retrospective study on 602 elderly hip fracture patients with previous stroke underwent surgical treatments in Shanghai Sixth People′s Hospital Affiliated to Shanghai Jiaotong University School of Medicine from March 2017 to September 2024 was conducted and general information of the patients,including their baseline data,basic comorbidities,previous stroke histories,preoperative complications,American Society of Anesthesiologists(ASA)score,age-adjusted Charlson comorbidity index(aCCI)score and modified Rankin scale(mRS)score were collected as evaluation indicators.Then,follow-up investigation of the patients experiencing adverse outcomes such as death or severe complications was conducted,and the independent factors were analyzed before constructing the nomogram model for risk prediction by using R rms packages.Results Among all 602 patients,78 patients(12.95%)had adverse outcomes.Intertrochanteric fracture,cardiac insufficiency,infection in lungs/urinary tracts,hypoproteinemia,electrolyte imbalance and mRS>2 scores were independent risk factors of adverse outcomes during the 90-day postoperative period of the patients[OR(95%CI)5.259(2.767-9.995),4.206(1.798-9.836),3.759(1.904-7.422),2.269(1.239-4.154),1.951(1.055-3.606),3.130(2.404-4.074)].Based on above 6 influencing factors,a nomogram was made and assessed with internal verification.The results showed the C-index was 0.901 with the 95%CI 0.868-0.934.Prediction curve was consistent with the actual incidence,the nomogram model had the good predictive ability.Conclusions Intertrochanteric fracture,cardiac insufficiency,infection in lungs/urinary tracts,hypoproteinemia,electrolyte imbalance and mRS>2 scores are independent risk factors of adverse outcomes in elderly hip fracture patients with previous stroke during the 90-day postoperative period.The nomogram model constructed in the study is of good value in predicting the occurrence of adverse outcomes during 90 days postoperatively.
作者
张霄周
封启明
Zhang Xiaozhou;Feng Qiming(Emergency Department,Shanghai Sixth People′s Hospital Affiliated to Shanghai Jiaotong University School of Medicine,Shanghai 200025,China)
出处
《中国急救医学》
2025年第6期476-481,共6页
Chinese Journal of Critical Care Medicine
作者简介
张霄周(1998-),男,硕士,E-mail:zss0204@126.com;通信作者:封启明(1966-),女,博士,主任医师,E-mail:fengqiming04@126.com。
