老年股骨转子间骨折围术期输血的相关因素

Factors related to perioperative blood transfusion in closed reduction and intramedullary nailing for femoral intertrochanteric fractures in the elderly

[目的]分析老年股骨转子间骨折围手术期输血的危险因素,建立预测模型,指导临床预判输血风险。[方法]回顾性分析2015年8月~2020年1月174例老年股骨转子间骨折髓内钉固定患者临床资料,分为输血组和未输血组,采用单因素和多因素分析,得出输血的危险因素。建立预测模型,对模型效能进行评定。[结果] 174例患者中,79例围手术期输血,占45.40%。单项因素比较,与未输血组相比,输血组患者年龄更大、不稳定型骨折占比更高、ASA分级更重、手术时间更长、术中出血量更多、入院时Hb和HCT更低、Cr更高,差异均有统计学意义(P<0.05)。多因素二元逻辑回归分析显示:高龄(OR=1.066,CI=1.011~1.124)、术中出血多(OR=1.007,CI=1.003~1.011)、入院时低血红蛋白(OR=0.924,CI=0.899~0.950)、扩髓(OR=5.147,CI=1.472~17.994)是输血的独立危险因素。基于逻辑回归结果所得的输血预测方程准确度为79.30%,临界值为0.595,敏感度为78.50%,特异度为81.10%;ROC曲线下面积为0.857。[结论]高龄、术中出血多、扩髓、入院时低血红蛋白是老年股骨转子间骨折围术期输血的独立危险因素,输血预测模型有助于临床判断是否输血。

[Objective] To analyze the factors related to blood transfusion during the perioperative period of closed reduction and internal fixation with intramedullary nail for femoral intertrochanteric fractures in the elderly, and establish a prediction model to guide clinical prediction of blood transfusion risk. [Methods] A retrospective study was conducted on 174 elderly patients who underwent closed reduction and intramedullary nailing for femoral intertrochanteric fractures from August 2015 to January 2020. The patients were divided into blood transfusion group and non-transfusion group, and compared by univariate and multivariate analysis to search the risk factors of blood transfusion. A predictive formula was established and verified for predicting blood transfusion. [Results] Among 174 patients, 79 patients had allogenic blood transfused during perioperative period, accounting for 45.40%. Compared with the non-transfusion group, patients in the blood transfusion group were significantly older, had a higher proportion of unstable fractures, severer ASA grade, longer operation time,more intraoperative blood loss, and lower Hb and HCT at admission, and higher Cr, which was statistically significant(P<0.05). As results of multivariate binary logistic regression analysis, advanced age(OR=1.066, CI=1.011~1.124), more intraoperative bleeding(OR=1.007, CI=1.003~1.011), low hemoglobin at admission(OR=0.924, CI=0.899~0.950) and intramedullary reaming(OR=5.147, CI=1.472~17.994)were independent risk factors for blood transfusion. Based on the logistic regression results, a prediction equation for blood transfusion was established with accuracy of 79.30%, threshold of 0.595, sensitivity of 78.50%, specificity of 81.10%, and area under the ROC curve of0.857. [Conclusion] The advanced age, excessive intraoperative bleeding, reaming, and low hemoglobin before operation are independent risk factors for perioperative blood transfusion in the elderly with intertrochanteric fractures. The blood-transfusion prediction equation is helpful to clinically judge whether blood transfusion.