高龄患者股骨颈骨折术后肺部感染预测模型的构建

Construction of a predictive model for postoperative pulmonary infection in elderly patients with femoral neck fractures

目的探讨高龄患者股骨颈骨折术后肺部感染预测模型的构建。方法选择2019年9月-2022年6月在温州市中西医结合医院骨科病区治疗的192例高龄股骨颈骨折患者,收集患者性别、年龄、文化程度、美国麻醉医师协会分级、手术方式、受伤至手术时间、机械通气时间、术中出血量、术前基础疾病(糖尿病、高血压、高血脂、冠心病、慢肺阻、贫血)、美国国立卫生研究院卒中量表(NIHSS)评分、意识障碍、吞咽障碍、致伤原因、低蛋白血症、住院时间、体质量指数、吸烟史、饮酒史、骨折Garden分型和抗骨质疏松治疗,根据术后肺部感染情况,将患者分成肺部感染组(n=40)和非肺部感染组(n=152);单因素筛选患者基线资料,并应用多因素Logistic回归分析确定影响患者术后肺部感染的危险因素,并建立肺部感染的预测模型。结果Logistic回归分析结果显示,慢性肺部疾病、Garden分型、NIHSS评分和机械通气时间是高龄股骨颈骨折患者术后肺部感染的危险因素(P<0.05);Logistic回归模型为logit(P)=0.619+0.231X_(Garden)分型+0.409X_(NIHSS评分)+0.513X_(机械通气)+0.641X_(慢性肺部疾病)。结论高龄股骨颈骨折患者肺部感染受多种因素影响,其中慢性肺部疾病、NIHSS评分和机械通气时间等是其危险因素,临床应制定相应的防范措施,以降低患者术后肺部感染,改善股骨颈骨折患者生活质量。

OBJECTIVE To explore the construction and application of predictive model for postoperative pulmonary infection in elderly patients with femoral neck fracture.METHODS A cohort comprising 192 elderly patients with femoral neck fractures,who underwent treatment at the joint surgery department of Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine between Sep 2019 and Jun 2022 were recruited.Patients'demographics including gender,age and education level,American society of anesthesiologists classification,surgical approach,time from injury to surgery,duration of mechanical ventilation,intraoperative blood loss,preoperative basic diseases(diabetes,hypertension,hyperlipidemia,coronary heart disease,chronic obstructive pulmonary disease and anemia),NIH Stroke Scale score,consciousness disorders,swallowing disorders,injury mechanism,hypoalbuminemia,length of hospital stay,body mass index,smoking history,alcohol consumption history,Garden classification of fractures,and anti-osteoporosis treatment were collected.Based on postoperative pulmonary infection status,patients were divided into the pulmonary infection group(n=4o)and non-pulmonary infection group(n=152).Baseline data of patients were screened by univariate analysis.Multivariate logistic regression analysis was applied to identify the independent risk factors for postoperative pulmonary infection,and a predictive model for pulmonary infection was established.RESULTS Multivariate logistic regression analysis showed that chronic lung disease,Garden classification,NIHSS score,and duration of mechanical ventilation were the risk factors for the a postoperative pulmonary infection in elderly patients with femoral neck fractures(P<o.05).The logistic regression model was formulated as logit(P)=-0.619+0.231X_(Garde classification)+0.409X_(NIHSS score)+0.513X_(mechanical ventilaion)+0.641X_(chronic lung disease).CONCLUSION Pulmonary infections in elderly patients with femoral neck fractures are influenced by many factors,in which chronic lung disease,NIHSS score,and the duration of mechanical ventilation are the risk factors.Corresponding preventive measures should be made in clinical practice to reduce postoperative pulmonary infection and improve the overall quality of life for individuals with femoral neck fracture.