| 梅海峰,梁宗敏,邰慧宇,等.改良虚弱指数对老年脑外伤术后发生肺部感染及预后的评估价值[J].安徽医药,2022,26(7):1425-1428. |
| 改良虚弱指数对老年脑外伤术后发生肺部感染及预后的评估价值 |
| Clinical value of modified frailty index on postoperative pulmonary infection and prognosis in the elderly patients with traumatic brain injury |
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| DOI：10.3969/j.issn.1009-6469.2022.07.035 |
| 中文关键词: 脑损伤 肺部感染 预后 改良虚弱指数 手术后并发症 老年人 |
| 英文关键词: Brain injuries Pulmonary infection Prognosis Modified frailty index Postoperative complications Aged |
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| 中文摘要: |
| 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， Kaplan-Meier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)(Log-rank 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。 |
| 英文摘要: |
| Objective To analyze the clinical value of modified frailty index (mFI) on postoperative pulmonary infection and progno-sis in the elderly patients with traumatic brain injury (TBI).Methods A total of 98 elderly patients with cerebral trauma who were ad-mitted to Taizhou People's Hospital from January 2016 to January 2020 were retrospectively selected and assigned into the infectedgroup and the non-infected group. Clinical and laboratory related indicators were compared between the two groups. Risk factors forpulmonary infection were evaluated by multivariate Logistic regression analysis. ROC curve was used to evaluate and compare the pre-dictive 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 anal-ysis indicated that mFI, CRP and PCT were three independent risk factors for pulmonary infection after TBI. ROC curve results suggest-ed that mFI, CRP and PCT could effectively predict the occurrence of postoperative pulmonary infection, and mFI had the best predic-tive value. Patients with high mFI expression (mFI≥0.18) had significantly lower overall survival rate at 30 days after surgery than thosewith low mFI expression (mFI<0.18) (log-rank P=0.005).Conclusion The mFI is an independent predictor for postoperative pulmo-nary infection, and is an important prognostic indicator in elderly TBI patients. |
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