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中华老年骨科与康复电子杂志[ISSN:1674-3911/CN:11-9292/R]

卷:

期数:

2024年02期

页码:

96-102

栏目:

髋部骨折

出版日期:

2024-04-05

文章信息/Info

Title:

Influencing factors of adverse cardiac events after hip fracture in the elderly and the predictive value of cTnI and CKMB

作者:

蒋坤寅1; 韩少宇2; 郝成俊1; 杨峰1; 张振清1

223300 淮安市第五人民医院骨科1，急诊科2

Author(s):

Jiang Kunyin1;  Han Shaoyu2;  Hao Chengjun1;  Yang Feng1;  Zhang Zhenqing1.

Department of Orthopedics, Fifth People’s Hospital of Huai’an, Huai’an 223001, China; 2Emergency Department of Huai’an Fifth People’s Hospital, Huai’an 223001, China

关键词:

髋部骨折;  老年患者;  心脏不良事件;  心肌肌钙蛋白T;  肌酸激酶同工酶

Keywords:

Hip fracture;  Elderly patients;  Adverse cardiac events;  Cardiac troponin T;  Creatine kinase isoenzyme

DOI:

10.3877/cma.j.issn.2096-0263.2024.02.005

文献标志码:

A

摘要:

目的 探究老年髋部骨折术后心脏不良事件的影响因素，并分析心肌肌钙蛋白I（cTnI）和肌酸激酶同工酶（CKMB）对其预测价值。方法 选取2018年6月至2021年6月期间本院符合上述纳入排除排除标准的行手术治疗老年髋部骨折患者392例临床资料开展回顾性分析，其中术后住院期间新发心脏不良事件情况58例。比较两组患者的一般资料、手术相关信息及血清学指标差异，以Logistic回归分析老年髋部骨折术后心脏不良事件的影响因素，以ROC曲线分析cTnI和CKMB水平对术后心脏不良事件的预测价值。结果 多因素Logistic回归分析显示，高龄、合并症≥3种、低白蛋白、低血红蛋白、高cTnI、高CKMB为术后心脏不良事件的危险因素（OR=8.000、2.459、1.369、1.165、4.650、1.134，P＜0.05）；ASA分级Ⅰ-Ⅱ级为术后心脏不良事件的保护因素（OR=0.410，P＜0.05）。ROC曲线分析显示，cTnI、CKMB及二者联合老年髋部骨折术后心脏不良事件预测的AUC分别为0.903、0.793、0.928。生存分析显示，cTnI＜0.195ng/ml、CKMB<35.85ng/ml患者平均生存时间均显著高于cTnI≥0.19ng/ml、CKMB≥35.85ng/ml患者（P＜0.05）。结论 高龄、合并症≥3种及营养缺乏为老年髋部骨折术后心脏不良事件的影响因素，cTnI及CKMB水平对老年髋部骨折术后心脏不良事件及预后均具有一定预测价值。

Abstract:

Objective Explore the influencing factors of adverse cardiac events after hip fracture in the elderly, and analyze the predictive value of cardiac troponin I (cTnI) and creatine kinase isoenzyme (CKMB). Methods The clinical data of 392 cases of elderly hip fracture patients who underwent surgical treatment between June 2018 and June 2021 in our hospital who met the above inclusion exclusion exclusion criteria were selected for retrospective analysis, including 58 cases of new adverse cardiac events during postoperative hospitalization. The difference of general data, operation related information and serological indexes between the two groups was compared, and the influencing factors of adverse cardiac events after hip fracture surgery in the elderly were analyzed by logistic regression; ROC curve was used to analyze the predictive value of cTnI and CKMB levels for postoperative adverse cardiac events. Results Multivariate logistic regression analysis showed that older age, ≥3 complications, low albumin, low hemoglobin, high cTnI, and high CKMB were the risk factors for adverse cardiac events (OR=8.000, 2.459, 1.369, 1.165, 4.650, 1.134, P<0.05); ASAⅠ-Ⅱ was the protective factor of postoperative cardiac adverse events (OR=0.410, P<0.05). ROC curve analysis showed that the AUC predicted by cTnI, CKMB and their combination after hip fracture surgery in the elderly were 0.903, 0.793 and 0.928, respectively. Survival analysis showed that the mean survival time of patients with cTnI<0.195 ng/ml and CKMB<35.85 ng/ml was significantly higher than that of patients with cTnI≥0.19 ng/ml and CKMB≥35.85 ng/ml (P<0.05). Conclusions Old age, ≥3 complications and nutritional deficiency are the influencing factors of cardiac adverse events after hip fracture surgery in the elderly. cTnI and CKMB levels have certain predictive value for cardiac adverse events and prognosis after hip fracture surgery in the elderly.

备注/Memo

备注/Memo:

基金项目：江苏省青年医学重点人才项目（QNRC2016801）

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更新日期/Last Update: 2024-08-01