本文選題：血漿N末端B型利鈉肽原 + 老年髖部骨折��； 參考：《廣東醫(yī)學(xué)》2017年05期

【摘要】：目的探討老年髖部骨折患者血漿N末端B型利鈉肽原(NT-proBNP)水平與疾病嚴(yán)重程度和治療方案制定的可能關(guān)系,以及其對(duì)預(yù)后的預(yù)測(cè)價(jià)值。方法采用回顧性病例對(duì)照研究方法,分析髖部損傷科和重癥醫(yī)學(xué)科(ICU)收治的老年髖部骨折患者的臨床資料,根據(jù)有無(wú)手術(shù)禁忌分為手術(shù)組、保守治療組;根據(jù)6個(gè)月預(yù)后分為存活組和死亡組;根據(jù)患者體質(zhì)狀況對(duì)手術(shù)危險(xiǎn)性分為ASAⅠ、Ⅱ、Ⅲ、Ⅳ級(jí);根據(jù)血漿NT-proBNP水平分為正常組、低水平組、中等水平組、高水平組。納入年齡≥65歲。收集患者入院第2天清晨血漿NT-proBNP值、急性生理學(xué)與慢性健康狀況評(píng)分系統(tǒng)Ⅱ(APACHEⅡ)評(píng)分、ASA分級(jí)情況,并追蹤統(tǒng)計(jì)6個(gè)月病死率。比較不同組間患者的基本資料,采用Pearson或Spearman相關(guān)法分析各參數(shù)間的相關(guān)性;采用受試者工作特征曲線(ROC)評(píng)估NT-proBNP對(duì)老年髖部骨折患者預(yù)后的評(píng)估價(jià)值。結(jié)果 (1)老年髖部骨折患者血漿NT-proBNP水平與APACHEⅡ評(píng)分呈顯著正相關(guān)(r=0.831,P=0.000)。(2)保守治療組血漿NT-proBNP水平和異常率以及APACHEⅡ評(píng)分、6個(gè)月病死率均較手術(shù)組顯著升高(P0.01)。(3)死亡組年齡、血漿NT-proBNP水平及APACHEⅡ評(píng)分均較存活組顯著升高(P0.05,P0.01)。(4)隨ASA級(jí)別升高,NT-proBNP水平和6個(gè)月病死率逐漸升高(P0.01)。(5)隨NT-proBNP水平升高,APACHEⅡ評(píng)分和6個(gè)月病死率逐漸升高(P0.01)。(6)NT-proBNP評(píng)估老年髖部骨折患者預(yù)后的ROC曲線下面積(AUC)為0.971[95%可信區(qū)間(95%CI)=0.939~1.000,P=0.000];當(dāng)截點(diǎn)值為1 281.50 pg/m L時(shí),預(yù)測(cè)患者6個(gè)月病死率的敏感度為100%,特異度為82.5%。結(jié)論老年髖部骨折患者血漿NT-proBNP水平與疾病嚴(yán)重程度呈正相關(guān),可協(xié)助術(shù)前評(píng)估手術(shù)風(fēng)險(xiǎn),對(duì)患者的預(yù)后有預(yù)測(cè)價(jià)值。
[Abstract]:Objective to investigate the possible relationship between plasma N-terminal B-type natriuretic peptide (NT-proBNPP) level and severity of the disease and the treatment plan in elderly patients with hip fracture and its prognostic value. Methods A retrospective case-control study was conducted to analyze the clinical data of elderly patients with hip fracture treated by Department of Hip injury and Department of intensive Medicine (ICU). The patients were divided into operation group and conservative treatment group according to the operative contraindications. According to the prognosis of 6 months, the patients were divided into survival group and death group, ASA 鈪，

本文編號(hào)：1885445