围手术期营养风险与髋部骨折患者静脉血栓栓塞症的关系

doi:10.11958/20230273

天津医药 ›› 2024, Vol. 52 ›› Issue (1): 97-101.doi: 10.11958/20230273

围手术期营养风险与髋部骨折患者静脉血栓栓塞症的关系

何苗¹(), 彭容², 田金山¹, 刘璇³, 邓磊¹, 吴茜⁴^,^△()

1.成都大学附属医院麻醉科（邮编610081）
2.成都大学附属医院临床营养科（邮编610081）
3.成都大学附属医院骨科（邮编610081）
4.成都大学附属医院药物临床试验中心（邮编610081）

收稿日期:2023-04-12 出版日期:2024-01-15 发布日期:2024-01-18
通讯作者: ^△E-mail：wuqiancdfy@163.com
作者简介:何苗（1987），女，主治医师，主要从事围手术期营养与麻醉安全方面研究。E-mail：hemiao920@126.com
基金资助:
成都市卫生健康委员会医学科研项目(2020134);四川省医疗卫生与健康促进会省级科研项目(KY2022SJ0044);四川省医学会静脉血栓栓塞症专项课题(2019HR50)

Relationship between perioperative nutrition risk and venous thromboembolism in patients with hip fracture

HE Miao¹(), PENG Rong², TIAN Jinshan¹, LIU Xuan³, DENG Lei¹, WU Qian⁴^,^△()

1. Department of Anesthesiology, Affiliated Hospital of Chengdu University, Chengdu 610081, China
2. Department of Anesthesiology, Department of Clinical Nutrition, Affiliated Hospital of Chengdu University, Chengdu 610081, China
3. Department of Anesthesiology, Department of Orthopedics, Affiliated Hospital of Chengdu University, Chengdu 610081, China
4. Department of Anesthesiology, Drug Clinical Trial Center, Affiliated Hospital of Chengdu University, Chengdu 610081, China

Received:2023-04-12 Published:2024-01-15 Online:2024-01-18
Contact: ^△E-mail：wuqiancdfy@163.com

何苗, 彭容, 田金山, 刘璇, 邓磊, 吴茜. 围手术期营养风险与髋部骨折患者静脉血栓栓塞症的关系[J]. 天津医药, 2024, 52(1): 97-101.

HE Miao, PENG Rong, TIAN Jinshan, LIU Xuan, DENG Lei, WU Qian. Relationship between perioperative nutrition risk and venous thromboembolism in patients with hip fracture[J]. Tianjin Medical Journal, 2024, 52(1): 97-101.

摘要/Abstract

摘要：

目的探讨围手术期营养风险与髋部骨折患者静脉血栓栓塞症（VTE）的关系。方法选取因摔伤或扭伤导致单侧髋部骨折择期行外科手术患者379例，根据围手术期是否发生VTE分为非VTE组（246例）和VTE组（133例），收集2组患者的基本信息、手术和麻醉记录、营养风险相关指标和炎症指标；采用多因素Logistic回归分析围手术期VTE的独立影响因素；受试者工作特征（ROC）曲线评估独立因素的鉴别能力，并用DeLong检验比较曲线下面积（AUC）。结果与非VTE组比较，VTE组年龄偏大，合并高血压、就诊时间>2 d、接受（空心/髓内钉）内固定手术、围手术期输血和美国麻醉医师协会（ASA）Ⅲ—Ⅳ级患者比例，入院时NRS（营养风险筛查表）-2002评分和术后中性粒细胞/淋巴细胞比值（NLR）更高；入院时和术后预后营养指数（PNI）、血红蛋白（Hb），入院时前白蛋白（PA）均低于非VTE组（P<0.01）；多因素Logistic回归分析显示，患者行内固定术，入院时PNI降低，NRS-2002评分和PA升高，就诊时间>2 d，ASA Ⅲ—Ⅳ级是髋部骨折围手术期发生VTE的独立危险因素（P<0.05）。ROC曲线分析显示，入院时NRS-2002的AUC（95%CI）为0.739（0.692~0.783），入院时PNI的AUC（95%CI）为0.720（0.672~0.765），两者的预测价值优于其他影响因素（P<0.01）。结论髋部骨折患者入院时NRS-2002和PNI对围手术期VTE具有一定的预测价值。

关键词: 静脉血栓栓塞, 髋骨折, 围手术期, 营养风险筛查表-2002, 预后营养指数

Abstract:

Objective To investigate the relationship between perioperative nutritional risk and venous thromboembolism (VTE) in patients with hip fracture. Methods A total of 379 patients with unilateral hip fracture due to fall or sprain who underwent elective surgery were selected and divided into the non-VTE group (246 cases) and the VTE group (133 cases) according to whether or not VTE occurred during perioperative period. Basic information, surgical and anesthesia records, nutritional risk related indicators, inflammatory indicators and outcome indicators of patients were collected. Multiple Logistic regression was used to analyze the independent influencing factors of perioperative VTE. Receiver operating characteristics (ROC) curves were used to assess the ability to discriminate independent factors, and DeLong test was used to compare area under the curve (AUC). Results Compared with the non-VTE group, the proportion of patients in the VTE group was older, complicated with hypertension, the time to visit hospital more than 2 days, received (hollow/intramedullary nail) internal fixation, perioperative blood transfusion, ASA grade Ⅲ to Ⅳ, and higher nutritional risk screening Table (NRS) -2002 scores on admission and higher postoperative neutrophil/lymphocyte ratio (NLR). Nutritional prognosis index (PNI), hemoglobin (Hb) and prealbumin (PA) at admission and after operation were lower in the VTE group than those in the non-VTE group (P<0.01). Multivariate Logistic regression analysis showed that PNI was decreased, NRS-2002 scores and PA were increased, and the time of visit hospital was > 2 days after internal fixation. American College of Anesthesiologists (ASA) grades Ⅲ-Ⅳ were independent risk factors for perioperative VTE of hip fracture (P<0.05). ROC curve analysis showed that the AUC (95%CI) of NRS-2002 at admission was 0.739 (0.692-0.783), and that of PNI at admission was 0.720 (0.672-0.765), both of which were better than other influencing factors (P<0.01). Conclusion NRS-2002 and PNI are good predictors of perioperative VTE in patients with hip fracture.

Key words: venous thromboembolism, hip fractures, perioperative period, nutritional risk screening-2002, prognostic nutritional index

中图分类号:

R614，R151

图/表 4

参考文献 29

[1]	SCHUETZ P, SERES D, LOBO D N, et al. Management of disease-related malnutrition for patients being treated in hospital[J]. Lancet, 2021, 398(10314):1927-1938. doi:10.1016/S0140-6736(21)01451-3.
[2]	HOLM M O, MIKKELSEN S, ZACHER N, et al. High risk of disease-related malnutrition in gastroenterology outpatients[J]. Nutrition, 2020, 75/76:110747. doi:10.1016/j.nut.2020.110747.
[3]	白成云, 李忠诚, 李文军, 等. 食管癌患者血清IGFBP-2的表达与营养状态及预后的关系[J]. 天津医药, 2022, 50(6):622-626.
	BAI C Y, LI Z C, LI W J, et al. The expression of serum IGFBP-2 in patients with esophageal cancer and its relationship with nutritional status and prognosis[J]. Tianjin Med J, 2022, 50(6):622-626. doi:10.11958/20212066.
[4]	岳向峰, 张献娜, 王雨, 等. 营养风险筛查(NRS 2002-01.017)、营养不良诊断(GLIM-表现型指标01.028、病因型指标01.029)[J]. 中华临床营养杂志, 2021, 29(2):123-128.
	YUE X F, ZHANG X N, WANG Y, et al. Terminology interpretation of nutritional risk screening(NRS 2002-01.017)and malnutrition diagnosis(GLIM-phenotypic criteria 01.028,etiologic criteria 01.029)[J]. Chinese Journal of Clinical Nutrition, 2021, 29(2):123-128. doi:10.3760/cma.j.cn115822-20201113-00239.
[5]	ŚCISŁO L, BIZOŃ A, WALEWSKA E, et al. Nutritional status of elderly patients after coronary artery bypass surgery[J]. Int J Environ Res Public Health, 2019, 16(2):226. doi:10.3390/ijerph16020226.
[6]	ZHAI Z, KAN Q, LI W, et al. VTE risk profiles and prophylaxis in medical and surgical inpatients:The identification of Chinese hospitalized patients' risk profile for venous thromboembolism(DissolVE-2)-a cross-sectional study[J]. Chest, 2019, 155(1):114-122. doi:10.1016/j.chest.2018.09.020.
[7]	NEMETH B, NELISSEN R, ARYA R, et al. Preventing VTE following total hip and knee arthroplasty:is prediction the future?[J]. J Thromb Haemost, 2021, 19(1):41-45. doi:10.1111/jth.15132.
[8]	朱雅, 金莉雅, 陈玉梅, 等. 三位一体共管模式在骨科大手术患者围术期静脉血栓栓塞症预防中的应用[J]. 中华创伤杂志, 2021, 37(8):739-743.
	ZHU Y, JIN L Y, CHEN Y M, et al. Application of "trinity" co-management mode in prevention of perioperative venous thromboembolism in patients treated with major orthopedic surgery[J]. Chin J Trauma, 2021, 37(8):739-743. doi:10.3760/cma.j.cn501098-20210416-00246.
[9]	NOGUCHI T, IKEDA K, SASAKI Y, et al. Nutritional prevention on hypertension, cerebral hemodynamics and thrombosis in stroke-prone spontaneously hypertensive rats[J]. Cell Mol Neurobiol, 2004, 24(5):599-638. doi:10.1023/b:cemn.0000036401.41492.24.
[10]	TOKAJUK A, ZAKRZESKA A, CHABIELSKA E, et al. Whey protein concentrate limits venous thrombosis in rats[J]. Appl Physiol Nutr Metab, 2019, 44(8):907-910. doi:10.1139/apnm-2018-0788.
[11]	HE M, FAN Q, ZHU Y, et al. The need for nutritional assessment and interventions based on the prognostic nutritional index for patients with femoral fractures:a retrospective study[J]. Perioper Med(Lond), 2021, 10(1):61. doi:10.1186/s13741-021-00232-1.
[12]	周武, 曹发奇, 曾睿寅, 等. 创伤骨科患者围术期下肢静脉血栓形成诊断及防治专家共识(2022年)[J]. 中华创伤杂志, 2022, 38(1):23-31.
	ZHOU W, CAO F Q, ZENG R Y, et al. Expert consensus on diagnosis, prevention and treatment of perioperative lower extremity vein thrombosis in orthopedic trauma patients(2022 edition)[J]. Chin J Trauma, 2022, 38(1):23-31. doi:10.3760/cma.j.cn501098-20210822-00451.
[13]	THOMAS M N, KUFELDT J, KISSER U, et al. Effects of malnutrition on complication rates,length of hospital stay, and revenue in elective surgical patients in the G-DRG-system[J]. Nutrition, 2016, 32(2):249-254. doi:10.1016/j.nut.2015.08.021.
[14]	GEURDEN B, FRANCK E, WEYLER J, et al. The risk of malnutrition in community-living elderly on admission to hospital for major surgery[J]. Acta Chir Belg, 2015, 115(5):341-347. doi:10.1080/00015458.2015.11681126.
[15]	ZHANG F, HE S T, ZHANG Y, et al. Malnutrition is not related with emergence delirium in older patients after noncardiac surgery[J]. BMC Geriatr, 2021, 21(1):319. doi:10.1186/s12877-021-02270-2.
[16]	KIM E, LEE D H, JANG J Y. Effects of preoperative malnutrition on postoperative surgical outcomes and quality of life of elderly patients with periampullary neoplasms:A single-center prospective cohort study[J]. Gut Liver, 2019, 13(6):690-697. doi:10.5009/gnl18469.
[17]	SARI M, ILHAN Y, SEZGIN GOKSU S, et al. The relationship between nutritional parameters and thrombosis risk in cancer patients[J]. Nutr Cancer, 2022, 74(4):1370-1375. doi:10.1080/01635581.2021.1952631.
[18]	DANWANG C, BIGNA J J, AWANA A P, et al. Global epidemiology of venous thromboembolism in people with active tuberculosis:a systematic review and meta-analysis[J]. J Thromb Thrombolysis, 2021, 51(2):502-512. doi:10.1007/s11239-020-02211-7.
[19]	JIMÉNEZ D, GARCÍA-SANCHEZ A, RALI P, et al. Incidence of VTE and bleeding among hospitalized patients with coronavirus disease 2019:A systematic review and meta-analysis[J]. Chest, 2021, 159(3):1182-1196. doi:10.1016/j.chest.2020.11.005.
[20]	XIN X, HUANG H, LU W, et al. Albumin concentration is a candidate indicator for predicting the risk of calf venous thromboembolism in patients undergoing gynecologic surgery[J]. Int J Gynaecol Obstet, 2022, 156(1):139-144. doi:10.1002/ijgo.13675.
[21]	LIJFERING W M, CANNEGIETER S C. Nutrition and venous thrombosis:An exercise in thinking about survivor bias[J]. Res Pract Thromb Haemost, 2018, 3(1):6-8. doi:10.1002/rth2.12174.
[22]	戴军, 赵鉴非, 佟刚. 老年髋部骨折内固定与人工髋关节置换术的临床疗效比较[J]. 创伤外科杂志, 2016, 18(2):105-108.
	DAI J, ZHAO J F, TONG G. Clinical curative effect comparison of internal fixation and artificial joint replacement in treating hip fracture in elderly patients[J]. J Trauma Surg, 2016, 18(2):105-108. doi:10.3969/j.issn.1009-4237.2016.02.012.
[23]	HACKETT N J, DE OLIVEIRA G S, JAIN U K, et al. ASA class is a reliable independent predictor of medical complications and mortality following surgery[J]. Int J Surg, 2015, 18:184-190. doi:10.1016/j.ijsu.2015.04.079.
[24]	POLOK K, PILECKI Z, KUTAJ-WĄSIKOWSKA H, et al. Time from admission to surgery in Polish patients with hip fractures:temporal trends in the last decade and association with duration of hospitalization and in-hospital mortality[J]. Pol Arch Intern Med, 2020, 130(6):506-511. doi:10.20452/pamw.15342.
[25]	VIDAL E I, MOREIRA-FILHO D C, COELI C M, et al. Hip fracture in the elderly: does counting time from fracture to surgery or from hospital admission to surgery matter when studying in-hospital mortality?[J]. Osteoporos Int, 2009, 20(5):723-729. doi:10.1007/s00198-008-0757-1.
[26]	GAO P, LIU J, WANG X, et al. The association between neutrophil-lymphocyte ratio and poor outcomes following infant cardiac surgery[J]. BMC Cardiovasc Disord, 2021, 21(1):529. doi:10.1186/s12872-021-02345-3.
[27]	DAHL H, WARZ S I, WELLAND N L, et al. Factors associated with nutritional risk in patients receiving haemodialysis assessed by Nutritional Risk Screening 2002(NRS2002)[J]. J Ren Care, 2022, 48(2):112-118. doi:10.1111/jorc.12374.
[28]	IZUMI D, IDA S, HAYAMI M, et al. Increased rate of serum prealbumin level after preoperative enteral nutrition as an indicator of morbidity in gastrectomy for gastric cancer with outlet obstruction[J]. World J Surg, 2022, 46(3):624-630. doi:10.1007/s00268-021-06384-x.
[29]	SONG S, QIU P, WANG H, et al. Low preoperative serum prealbumin levels and risk of postoperative complications after transsphenoidal surgery in nonfunctioning pituitary adenoma[J]. Neurosurg Focus, 2022, 53(6):E6. doi:10.3171/2022.9.FOCUS22211.

变量	β	SE	Wald χ²	P	OR	OR95%CI
手术方式	1.087	0.309	12.385	<0.001	2.965	1.618~5.430
入院时PNI	-0.107	0.039	7.539	0.006	0.898	0.832~0.970
入院时NRS-2002评分	0.480	0.179	7.228	0.007	1.617	1.139~2.295
就诊时间	0.657	0.288	5.204	0.023	1.929	1.097~3.391
入院时PA	0.006	0.003	4.804	0.028	1.006	1.001~1.012
ASA分级	0.635	0.302	4.413	0.036	1.888	1.043~3.415

变量	β	SE	Wald χ²	P	OR	OR95%CI
手术方式	1.087	0.309	12.385	<0.001	2.965	1.618~5.430
入院时PNI	-0.107	0.039	7.539	0.006	0.898	0.832~0.970
入院时NRS-2002评分	0.480	0.179	7.228	0.007	1.617	1.139~2.295
就诊时间	0.657	0.288	5.204	0.023	1.929	1.097~3.391
入院时PA	0.006	0.003	4.804	0.028	1.006	1.001~1.012
ASA分级	0.635	0.302	4.413	0.036	1.888	1.043~3.415

指标	AUC（95%CI）	敏感度（%）	特异度（%）	约登指数	截断值	Z^a	Z^b
入院时NRS-2002评分	0.739（0.692~0.783）	72.18	73.17	0.454	3分		0.798
入院时PNI	0.720（0.672~0.765）	60.90	73.98	0.349	39.98	0.798
ASA分级	0.597（0.546-0.647）	36.09	83.33	0.194		4.537^＊＊	3.636^＊＊
入院时PA	0.590（0.539~0.640）	38.35	79.67	0.180	137.5 mg/L	4.901^＊＊	4.864^＊＊
手术方式	0.588（0.536~0.638）	64.66	52.85	0.175		4.072^＊＊	3.718^＊＊
就诊时间	0.555（0.504~0.606）	39.10	71.95	0.111		5.406^＊＊	4.587^＊＊

指标	AUC（95%CI）	敏感度（%）	特异度（%）	约登指数	截断值	Z^a	Z^b
入院时NRS-2002评分	0.739（0.692~0.783）	72.18	73.17	0.454	3分		0.798
入院时PNI	0.720（0.672~0.765）	60.90	73.98	0.349	39.98	0.798
ASA分级	0.597（0.546-0.647）	36.09	83.33	0.194		4.537^＊＊	3.636^＊＊
入院时PA	0.590（0.539~0.640）	38.35	79.67	0.180	137.5 mg/L	4.901^＊＊	4.864^＊＊
手术方式	0.588（0.536~0.638）	64.66	52.85	0.175		4.072^＊＊	3.718^＊＊
就诊时间	0.555（0.504~0.606）	39.10	71.95	0.111		5.406^＊＊	4.587^＊＊

围手术期营养风险与髋部骨折患者静脉血栓栓塞症的关系

Relationship between perioperative nutrition risk and venous thromboembolism in patients with hip fracture

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