老年髋部骨折术后低磷血症的发生及对预后的影响

HYPOPHOSPHATEMIA AFTER HIP FRACTURE SURGERY IN ELDERLY PATIENTS AND ITS INFLUENCE ON PROGNOSIS

目的观察重症医学科(ICU)内老年髋部骨折术后病人低磷血症的发生情况,探讨低磷血症对预后的预测价值。方法纳入2021年7月—2022年8月北京积水潭医院ICU收治的老年髋部骨折术后病人110例,将入ICU即刻血磷<0.8 mmol/L者归为低磷组,血磷≥0.8 mmol/L者归为正常组。比较两组术中情况(手术方式、术中失血量)、主要血化验检查(白细胞、血红蛋白、清蛋白、肌酐、脑利钠肽、心肌肌钙蛋白I、乳酸)、主要并发症(急性心功能不全、心房颤动、谵妄、术后呼吸衰竭、脑梗死)及临床预后指标(ICU住院时间、住院病死率、术后住院时间)。结果在老年髋部骨折术后进入ICU病人中,低磷血症发生率为37.2%(41/110)。低磷组病人急性心功能不全的发生率显著高于正常组(χ^(2)=4.875,P=0.025),两组其他指标差异均无统计学意义。血磷水平预测ICU内老年髋部骨折术后病人发生急性心功能不全的受试者工作特征曲线曲线下面积为0.851,95%置信区间为0.747~0.955;血磷最佳截断值为0.795 mmol/L,此时其诊断灵敏度为81.3%,特异度为70.2%。结论重症老年髋部骨折病人术后低磷血症发生率较高,且低磷血症与病人新发急性心功能不全有相关性。低磷血症可能对该病人群体术后急性心功能不全有一定预测作用。

Objective To investigate the onset of hypophosphatemia after hip fracture surgery in elderly patients in the intensive care unit(ICU)and its value in predicting prognosis.Methods A total of 110 elderly patients after hip fracture surgery who were admitted to the ICU of Beijing Jishuitan Hospital from July 2021 to August 2022 were enrolled,and according to the blood phosphorus level on admission to the ICU,they were divided into low phosphorus group(<0.8 mmol/L)and normal group(≥0.8 mmol/L).The two groups were compared in terms of intraoperative conditions(surgical procedure and intraoperative blood loss),major blood test results(white blood cell,hemoglobin,albumin,creatinine,brain natriuretic peptide,cardiac troponin I,and lactic acid),major complications(acute cardiac dysfunction,atrial fibrillation,delirium,postoperative respiratory failure,and cerebral infarction),and clinical prognostic indicators(length of ICU stay,mortality rate during hospitalization,and length of postoperative hospital stay).Results The incidence rate of hypophosphatemia was 37.2%(41/110)in the elderly patients who were admitted to the ICU after hip fracture surgery.The low phosphorus group had a significantly higher incidence rate of acute cardiac insufficiency than the normal group(χ^(2)=4.875,P=0.025),and there were no significant differences in the other indicators between the two groups.Blood phosphorus level had an area under the ROC curve of 0.851(95%CI=0.747-0.955)in predicting acute cardiac insufficiency in the elderly patients after hip fracture surgery,with a sensitivity of 81.3%and a specificity of 70.2%at the optimal cut-off value of 0.795 mmol/L.Conclusion There is a relatively high incidence rate of hypophosphatemia in elderly patients after hip fracture surgery,and hypophosphatemia is associated with new-onset acute cardiac insufficiency in such patients.Hypophosphatemia may be used as a predictive factor for postoperative acute cardiac insufficiency in this patient population.