老年髋部骨折患者术中发生静脉血栓栓塞的危险因素及预测分析

Risk factor and predictive analysis of intraoperative venous thromboembolism in elderly patient with hip fracture

目的探讨老年髋部骨折患者术中发生静脉血栓栓塞(VTE)的危险因素及多因素分析模型对老年髋部骨折患者术中发生VTE的预测效能。方法收集2020年10月至2021年9月于海安市人民医院接受手术治疗的126例老年髋部骨折患者的临床资料,根据术中VTE的发生情况分为对照组(n=70,未发生VTE)和病例组(n=56,发生VTE)。以单因素分析及多因素Logistic回归模型分析老年髋部骨折患者术中发生VTE的危险因素,并利用Logistic预测模型对危险因素进一步分析。结果病例组患者远端血栓的发生率为92.86%(52/56),近端血栓的发生率为7.14%(4/56)。单因素分析结果显示,两组患者的年龄、性别、骨折位置、骨折类型、体重指数、糖尿病情况、高血压情况、高脂血症情况、冠心病情况、心律失常情况、美国麻醉医师协会(ASA)分级、术前1 d的D-二聚体水平、术前1 d的C反应蛋白水平、术中出血量、手术输液量比较,差异均无统计学意义(P>0.05);两组患者的骨折至入院时间、骨折至手术时间、手术时间比较,差异均有统计学意义(P<0.05)。多因素分析结果显示,高血压是老年髋部骨折患者术中发生VTE的独立保护因素(OR=0.195,95%CI:0.148~0.257,P<0.05);骨折至入院时间(OR=1.035,95%CI:1.019~1.052)、骨折至手术时间(OR=1.027,95%CI:1.021~1.033)、手术时间(OR=1.041,95%CI:1.005~1.079)均是老年髋部骨折患者术中发生VTE的独立危险因素(P<0.05)。根据多因素Logistics回归分析结果构建预测模型,该模型预测老年髋部骨折患者术中发生VTE的最佳截断值为0.487,受试者工作特征(ROC)曲线下面积为0.938,诊断灵敏度、特异度分别为83.93%、87.14%,约登指数为71.07%。结论老年髋部骨折患者术中发生VTE的风险较高。高血压是老年髋部骨折患者术中发生VTE的独立保护因素,骨折至入院时间、骨折至手术时间、手术时间均是老年髋部骨折患者术中发生VTE的独立危险因素。通过危险因素的分析与预测模型的建立,可有效识别高危患者。

Objective To investigate the risk factor of intraoperative venous thromboembolism(VTE)in elderly hip fracture patients and the predictive power of a multivariate analysis model for intraoperative VTE in elderly hip fracture patients.Method The clinical data of 126 elderly patients with hip fractures who received surgical treatment in Hai’an Municipal People’s Hospital from October 2020 to September 2021 were collected and divided into control group(n=70,without VTE)and case group(n=56,VTE occurred)according to the occurrence of VTE during operation.Univariate analysis and Logistic multivariate regression model were used to analyze the risk factors of VTE in elderly hip fracture operation,and the Logistic mathematical model was built to further predict and analyze the risk factors.Result In the case group,the incidence rate of distal thrombus was 92.86%(52/56),and the incidence rate of proximal thrombus was 7.14%(4/56).The results of the univariate analysis showed that the age,gender,fracture location,fracture type,body mass index,diabetes,hypertension,hyperlipidemia,coronary heart disease,arrhythmia,American Society of Anesthesiologists(ASA)grading,and D-dimer level one day before the operation,C-reactive protein level one day before operation,intraoperative blood loss,and surgical infusion volume of the two groups of patients were compared,and there was no significant difference(P>0.05).There were significant differences in the time from fracture to hospital admission,time from fracture to operation,and operation time between the two groups(P<0.05).Multivariate analysis showed that hypertension was an independent protective factor for VTE in elderly patients with hip fracture(OR=0.195,95%CI:0.148-0.257,P<0.05).Time from fracture to hospital admission(OR=1.035,95%CI:1.019-1.052),time from fracture to operation(OR=1.027,95%CI:1.021-1.033),operation time(OR=1.041,95%CI:1.005-1.079)were independent risk factors for intraoperative VTE in elderly patients with hip fracture(P<0.05).According to the multivariate Logistic regression analysis results,a prediction model was constructed.The optimal cut-off value of the model for predicting the occurrence of VTE in elderly patients with hip fracture during the operation was 0.487,the receiver operating characteristic(ROC)area under curve was 0.938,the diagnostic sensitivity and specificity were 83.93%and 87.14%,respectively,and the Youden index was 71.07%.Conclusion Elderly patients with hip fracture have a higher risk of VTE during the operation.Hypertension is an independent protective factor for VTE during operation for elderly related hip fracture.The time from fracture to hospital admission,time from fracture to operation,and operation time are all independent risk factors for VTE in elderly patients with hip fracture.Through the analysis of risk factor and the establishment of prediction models,high-risk patients could be effectively identified.