摘要
目的 分析改良虚弱指数(mFI)在老年脑外伤病人术后肺部感染并发症发生及预后预测中的临床价值。方法 回顾性选取2016年1月至2020年1月期间泰州市人民医院收治的98例老年脑外伤病人,分为感染组和非感染组,比较两组病人临床及实验室相关指标,logistic回归分析探讨肺部感染危险因素。ROC曲线评估、比较各指标对肺部感染的预测价值,KaplanMeier曲线分析mFI与病人预后相关性。结果 共纳入98例老年脑外伤病人,其中感染组37例,无感染组61例,肺部感染发生率为37.8%(37/98)。感染组病人的年龄、术前急性生理与慢性健康评分(APACHE)Ⅱ[(21.9±3.8)分比(20.4±3.5)分,t=1.99,P=0.049]、手术时间、mFI[(0.22±0.06)比(0.16±0.04),t=5.94,P<0.001]、气管切开及机械通气比例C反应蛋白(CRP)[(36.4±9.1)mg/L比(31.3±6.9)mg/L,t=3.14,P=0.002]、降钙素原(PCT)[(12.3±3.8)μg/L比(10.5±2.9)μg/L,t=2.64,P=0.010]水平均高于非感染组病人,而白蛋白(Alb)[(35.2±3.7)g/L比(36.8±3.3)g/L,t=2.22,P=0.029]水平低于非感染组(P<0.05)。多因素logistic回归分析提示mFI、CRP和PCT是脑外伤术后肺部感染的三个独立危险因素;ROC曲线结果提示mFI、CRP、PCT均能有效预测术后肺部感染的发生,且mFI预测价值最佳;mFI高表达(mFI≥0.18)病人术后30 d总生存率低于mFI低表达病人(mFI<0.18)(Logrank P=0.005)。结论 mFI是老年脑外伤病人术后出现肺部感染的独立预测因素,且是一个重要的预后评价指标。
Objective To analyze the clinical value of modified frailty index(mFI) on postoperative pulmonary infection and prognosis in the elderly patients with traumatic brain injury(TBI).Methods A total of 98 elderly patients with cerebral trauma who were admitted to Taizhou People’s Hospital from January 2016 to January 2020 were retrospectively selected and assigned into the infected group and the non-infected group.Clinical and laboratory related indicators were compared between the two groups.Risk factors for pulmonary infection were evaluated by multivariate Logistic regression analysis.ROC curve was used to evaluate and compare the predictive value of indicators for pulmonary infection after TBI.Kaplan-Meier curve was used to analyze the correlation between mFI and prognosis.Results A total of 98 elderly patients with TBI were enrolled,including 37 in the infected group and 61 in the non-infected group,with an incidence of 37.8%(37/98).Age,preoperative APACHE Ⅱ score [(21.9±3.8) points vs.(20.4±3.5) points,t=1.99,P=0.049],operation time,mFI [(0.22±0.06) points vs.(0.16±0.04) points,t=5.94,P<0.001],tracheotomy and mechanical ventilation ratio,CRP [(36.4±9.1) mg/L vs.(31.3±6.9) mg/L,t=3.14,P=0.002] and PCT [(12.3±3.8) μg/L vs.(10.5±2.9)μg/L,t=2.64,P=0.010] levels of patients in the infected group were significantly higher than those in the non-infected group,while Alb [(35.2±3.7) g/L vs.(36.8±3.3) g/L,t=2.22,P=0.029] levels were significantly lower than those in the non-infected group(P<0.05).Multivariate Logistic regression analysis indicated that mFI,CRP and PCT were three independent risk factors for pulmonary infection after TBI.ROC curve results suggested that mFI,CRP and PCT could effectively predict the occurrence of postoperative pulmonary infection,and mFI had the best predictive value.Patients with high mFI expression(mFI≥0.18) had significantly lower overall survival rate at 30 days after surgery than those with low mFI expression(mFI<0.18)(log-rank P=0.005).Conclusion nary infection,and is an important prognostic indicator in elderly TBI patients.
作者
梅海峰
梁宗敏
邰慧宇
朱尚
朱志云
MEI Haifeng;LIANG Zongmin;TAI Huiyu;ZHU Shang;ZHU Zhiyun(Department of Intensive Care Unit,Taizhou People’s Hospital,Jiangsu,Taizhou 225300,China;Department of Infection Management,Taizhou People’s Hospital,Jiangsu,Taizhou 225300,China)
出处
《安徽医药》
CAS
2022年第7期1425-1428,共4页
Anhui Medical and Pharmaceutical Journal
关键词
脑损伤
肺部感染
预后
改良虚弱指数
手术后并发症
老年人
Brain injuries
Pulmonary infection
Prognosis
Modified frailty index
Postoperative complications
Aged
