| 蒋环萍,陈淑君.术后早期低白蛋白血症对髋部骨折术后肺炎的影响[J].浙江中西医结合杂志,2022,32(8): |
| 术后早期低白蛋白血症对髋部骨折术后肺炎的影响 |
| Effect of early postoperative hypoalbuminemia on postoperative pneumonia of hip fracture |
| 投稿时间：2021-10-21 修订日期：2022-02-11 |
| DOI： |
| 中文关键词: 髋部骨折 术后肺炎 低蛋白血症 |
| 英文关键词:Hip fracture Postoperative pneumonia hypoproteinemia |
| 基金项目: |
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| 摘要点击次数: 695 |
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| 中文摘要: |
| 目的：调查术后早期低白蛋白血症对髋部骨折术后肺炎的影响。方法：回顾性分析2011年1月至2020年10月在我院因髋关节骨折接受手术的1155例患者的病历资料。从前瞻性维护的数据库中采集患者的人口学、临床和术后早期血清白蛋白等实验室检查数据。采用多因素Logistic回归分析确定术后肺炎的预测因素。根据受试者工作特征(ROC)曲线，利用约登指数确定术后早期血清白蛋白预测术后肺炎的临界值。进一步将患者分为＜临界值组和≥临界值组，使用倾向评分匹配（PSM）方法来平衡两组之间的混杂因素。考察PSM前后两组患者发生术后肺炎的风险。结果：术后肺炎的发生率为5.1% (59/1155)。多因素Logistic回归分析显示早期血清白蛋白水平是术后肺炎的独立影响因素(OR: 0.113, 95%CI: 0.012－0.994, P = 0.015)。术后早期白蛋白水平预测术后肺炎的最佳临界值为30 g/L。ROC曲线下面积为0.734。将患者分为<30 g/L组 (n=602)和≥30 g/L组 (n=553)。PSM共匹配了446例患者，每组223例。PSM后，两组患者人口学和临床资料差异无统计学意义（P＞0.05），各项指标的SMD均＜0.10，表明组间均衡性良好。无论是匹配前[OR (95% CI): 3.310(1.688, 5.732), P<0.001]，还是PSM匹配后[OR (95% CI): 3.111(1.237, 7.825), P=0.016]，<30 g/L组患者发生术后肺炎的风险都是≥30 g/L组的3倍。结论：术后早期最低的血清白蛋白水平＜30 g/L是髋关节骨折手术后术后肺炎的重要预测因素。 |
| 英文摘要: |
| Objective: To investigate the effect of early postoperative hypoalbuminemia on postoperative pneumonia of hip fracture. Methods: The medical records of 1155 patients who underwent surgery for hip fracture in our hospital from January 2011 to October 2020 were retrospectively analyzed. Demographic, clinical, and early postoperative serum albumin laboratory data were collected from prospectively maintained databases. Multivariate Logistic regression analysis was used to determine the predictors of postoperative pneumonia and to evaluate the influence of albumin level on the development of postoperative pneumonia. According to the receiver operating characteristic (ROC) curve, the critical value of early postoperative serum albumin for predicting postoperative pneumonia was determined by Yoden index. Patients were further divided into < threshold group and ≥ threshold group, and propensity score matching (PSM) was used to balance for confounding factors between the two groups. The risk of postoperative pneumonia in the two groups before and after PSM was investigated. Results: The incidence of postoperative pneumonia was 5.1% (59/1155).Multivariate Logistic regression analysis showed that early serum albumin level was an independent factor for postoperative pneumonia (OR: 0.113, 95%CI: 0.012-0.994, P = 0.015).The optimal cut-off value of early postoperative albumin level to predict postoperative pneumonia was 30 g/L.The area under the ROC curve was 0.734.Patients were divided into lt;30 g/L group (n=602) and ≥30 g/L group (n=553).A total of 446 patients were matched by PSM, 223 in each group. After PSM, there were no statistically significant differences in demographic and clinical data between the two groups (P > 0.05), and SMD of all indicators were < 0.10, indicating good balance between the two groups. Whether it matches before [OR (95% CI) : 3.310 (1.688, 5.732), P< 0.001], OR the PSM match [OR (95% CI) : 3.111 (1.237, 7.825), P = 0.016), & lt;The risk of postoperative pneumonia in the 30 g/L group was 3 times higher than that in the ≥30 g/L group. Conclusion: The lowest serum albumin level < 30 g/L in the early postoperative period is an important predictor of postoperative pneumonia after hip fracture surgery. |
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