老年股骨转子间骨折患者围手术期血清肌酐尿素氮B型钠尿肽水平变化及临床意义探讨

doi:10.3969/j.issn.1006-6233.2021.06.019

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摘要 目的: 探究老年股骨转子间骨折患者围手术期血清肌酐(serum creatinine,Scr)、尿素氮(blood urea nitrogen,BUN)和B型钠尿肽(B-type natriuretic peptide,BNP)水平变化,分析影响患者术后预后不良的危险因素。方法: 回顾性分析2017年1月至2020年6月在本院接受手术治疗的147例老年股骨转子间骨折患者的临床资料,根据术后不良事件发生情况将患者分为预后良好组(n=122)和预后不良组(n=25)。比较两组患者的一般临床资料、不同时间点(术前、术后12h、24h、48h和72h)的血清Scr、BUN和BNP水平变化情况,采用多因素Logistic回归分析患者术后预后不良的独立危险因素。结果: 预后不良组患者的年龄、受伤至手术时间均长于预后良好组(P<0.05),ASA分级为Ⅲ/Ⅳ级、术前肾功能异常、围手术期液体出入量差值≥500mL的占比高于预后良好组(P<0.05),两组患者的性别、基础疾病史、手术时间、住院时间和麻醉方式比较无明显差异(P>0.05);术后,预后不良组的血清Scr和BNP水平呈先上升后下降的趋势,血清BUN水平逐渐上升;预后良好组的血清Scr、BUN和BNP水平呈先上升后下降的趋势;两组患者血清Scr、BUN和BNP水平组间、时间点及交互差异均有统计学意义(P<0.05),术后48h和72h,预后不良组的血清BUN水平明显高于预后良好组(P<0.05),术后12h、24h、48h和72h,预后不良组的血清BNP和Scr水平高于预后良好组(P<0.05);Logistic回归分析结果显示,患者年龄、ASA分级为Ⅲ/Ⅳ级、围手术期液体出入量差值≥500mL、术后72h血清Scr、BUN和BNP水平是老年股骨转子间骨折患者术后预后不良的影响因素(P<0.05)。结论: 老年股骨转子间骨折患者术后发生不良事件的影响因素包括年龄、ASA分级为Ⅲ/Ⅳ级、围手术期液体出入量差值≥500mL、术后72h血清Scr、BUN和BNP水平,对术后72h的血清Scr、BUN和BNP水平进行实时监测,并采取有效干预措施,可改善患者预后。

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	姜明菊
	胡勇

关键词 ：股骨转子间骨折, 老年患者, 血清学指标, 预后, 危险因素

Abstract：Objective: To explore changes of levels of serum creatinine (serum creatinine, Scr), blood urea nitrogen (blood urea nitrogen, BUN) and B-type natriuretic peptide (B-type natriuretic peptide, BNP) in perioperative period of elderly patients with femoral intertrochanteric fractures, and analyze the risk factors for poor prognosis of patients after operation. Methods:The clinical data of 147 elderly patients with intertrochanteric fractures who underwent surgical treatment in the hospital from January 2017 to June 2020 were retrospectively analyzed. According to the occurrence of adverse events, patients were divided into good prognosis group (n=122) and poor prognosis group (n=25). The general clinical data and changes in levels of serum Scr, BUN and BNP at different time points (before surgery, at 12h, 24h, 48h and 72h after surgery) were compared between the two groups. The independent risk factors of poor prognosis were analyzed by multivariate logistic regression analysis. Results:Older age and longer interval from injury to operation are observed in poor prognosis group than those in good prognosis group (P<0.05), and proportion of patients with ASA grading at grade III-IV, preoperative abnormal renal function and difference value of perioperative fluid intake and output not lower than 500mL was higher than that in good prognosis group (P<0.05). There were no significant differences in gender, history of underlying diseases, operation time, hospitalization time and anesthesia method between the two groups (P>0.05). After surgery, levels of serum Scr and BNP were increased and then decreased, and level of serum BUN was gradually increased in poor prognosis group. The levels of serum Scr, BUN and BNP were increased and then decreased in good prognosis group. The levels of serum Scr, BUN and BNP in the two groups showed statistically significant differences in terms of inter-group effect, time effect, and interaction effect (P<0.05). At 48h and 72h after operation, the poor prognosis group had significantly higher serum BUN levels than the good prognosis group (P<0.05). At 12h, 24h, 48h and 72h after operation, serum BNP and Scr levels in the poor prognosis group were higher than those in the good prognosis group (P<0.05).Logistic regression analysis showed that age, ASA grading at grade III-IV, difference value of perioperative fluid intake and output not lower than 500mL, levels of serum Scr, BUN and BNP levels at 72h after surgery were influencing factors of poor prognosis in elderly patients with intertrochanteric fractures (P<0.05). Conclusion:Influencing factors for postoperative poor prognosis in elderly patients with intertrochanteric fractures include age, ASA grading at grade III-IV, difference value of perioperative fluid intake and output not lower than 500mL, levels of serum Scr, BUN and BNP levels at 72h after surgery. The real-time monitoring on levels of serum Scr, BUN and BNP levels at 72h after surgery, and taking effective intervention measures can improve their prognosis.

Key words： Femoral intertrochanteric fracture Elderly patient Serological index Prognosis Risk factor

基金资助:海南省卫生计生行业科研课题,(编号:19A200023)

引用本文:

姜明菊, 胡勇. 老年股骨转子间骨折患者围手术期血清肌酐尿素氮B型钠尿肽水平变化及临床意义探讨[J]. 河北医学, 2021, 27(6): 968-974.
JIANG Mingju, HU Yong. Changes of Levels of Serum Creatinine Urea Nitrogen and B-Natriuretic Peptide in Perioperative Period of Elderly Patients with Femoral Intertrochanteric Fractures and the Clinical Significance. HeBei Med, 2021, 27(6): 968-974.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2021.06.019 或 http://www.hbyxzzs.cn/CN/Y2021/V27/I6/968

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