预后营养指数对老年股骨粗隆间骨折患者术后下肢深静脉血栓的影响及风险模型构建

Effect of Prognostic Nutritional Index on Postoperative Deep Vein Thrombosis of Elderly Patients with Femoral Intertrochanteric Fracture:A Risk Prognostic Model

目的探讨预后营养指数(PNI)等因素对老年(≥60岁)股骨粗隆间骨折患者术后发生下肢深静脉血栓(DVT)的影响。方法该研究共收纳了来自2家医院的157例老年股骨粗隆间骨折患者。记录并分析患者的年龄、性别、术前卧床天数、吸烟和饮酒习惯、外周血中性粒细胞、淋巴细胞、血小板以及多种外周血炎性细胞因子浓度,根据研究结果设计下肢血栓发生风险预测模型。结果低血清白蛋白含量,低外周血淋巴细胞计数、长时间卧床以及高IL-6水平是老年人股骨粗隆间骨折术后发生下肢DVT的重要危险因素。其他因素的变化对骨折术后血栓发生率无显著影响。基于上述发现,构建的预测模型可以更好地评估股骨粗隆间骨折术后血栓形成的风险,预防其发生。结论低PNI、长时间卧床、高炎症指标的老年股骨粗隆间骨折患者术后血栓风险高,术后营养不良是患者出现下肢DVT的高危因素。

Objective To investigate the influence of prognostic nutritional index(PNI)and other factors on the postoperative deep vein thrombosis(DVT)incidence of elderly patients(≥60 years old)with femoral intertrochanteric fracture.Methods Totally 157 elderly patients with intertrochanteric fracture from two hospitals were enrolled in this study.The patients'age,gender,preoperative bedrest time,smoking and drinking habits,concentration of neutrophil,lymphocyte,platelet and several kinds of inflammatory cytokines in peripheral blood were recorded and analyzed.The DVT prediction model was designed according to the results.Results Low serum albumin content,low peripheral blood lymphocyte count,prolonged bed rest,and high levels of IL-6 are important risk factors for lower limb DVT in elderly patients with femoral intertrochanteric fractures after surgery.Variations of other factors have no significant influence on the incidence of postoperative thrombosis.Based on the above findings,the constructed predictive model can better evaluate the risk of postoperative thrombosis in femoral intertrochanteric fracture patients and finally prevent it.Conclusion Elderly patients with low PNI,prolonged bed rest,and high inflammatory indicators have a high risk of postoperative DVT in femoral intertrochanteric fracture.Postoperative malnutrition especially indicates increased risk for lower limb DVT.