Predictive value of blood glucose gap for perioperative blood transfusion in elderly patients with lower limb fracture surgery
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摘要: 目的 探讨血糖间隙(glycemic gap，GG)对老年下肢骨折手术患者围术期输血的预测价值。方法 选取医院2020年1月至2023年11月期间收治的行择期手术治疗的老年下肢骨折患者161例，根据患者围术期是否输血将其分为输血组(n=38)和未输血组(n=123)。比较2组临床资料，绘制受试者工作特征曲线分析GG对老年下肢骨折手术患者围术期输血的预测价值。结果 多因素logistic回归分析结果显示：年龄(OR=3.255，95%CI 1.078~9.832)、体重指数(BMI)(OR=1.688，95%CI 0.958~2.974)、手术时间(OR=1.792，95%CI 0.880~3.650)、血红蛋白(Hb)(OR=3.469，95%CI 1.799~6.689)、GG(OR=2.827，95%CI 1.432~5.581)是老年下肢骨折患者围术期输血的重要影响因素(P < 0.05)。ROC曲线分析结果显示：年龄、BMI、手术时间、GG预测老年下肢骨折患者围术期输血的曲线下面积分别为0.629、0.677、0.637、0.774，其中以GG的预测价值最佳。结论 GG预测老年下肢骨折患者围术期输血具有良好的效能，且具有容易获取、计算简单等优势，可为临床鉴别高输血人群提供参考依据。Abstract: Objective To investigate the predictive value of blood glucose gap for perioperative blood transfusion in elderly patients undergoing lower limb fracture surgery.Methods From January 2020 to November 2020, 161 elderly patients with lower extremity fractures who underwent elective surgery in our hospital were selected, patients were divided into transfusion group(n=38) and non-transfusion group(n=123) according to whether or not they received blood transfusion during the perioperative period. The clinical data of the two groups were compared, and the ROC curve was drawn to analyze the predictive value of blood glucose gap for perioperative blood transfusion in elderly patients with lower extremity fracture.Results Multivariate logistic regression analysis showed that age(OR=3.255, 95%CI 1.078-9.832), BMI(OR=1.688, 95%CI 0.958-2.974), operation time(OR=1.792, 95%CI 0.880-3.650), Hb(OR=3.469, 95%CI 1.799-6.689), blood glucose gap(OR=2.827, 95%CI 1.432-5.581) were the important influencing factors of blood transfusion in the elderly patients with lower extremity fracture during perioperative period(P < 0.05). The results of ROC curve analysis showed that the area under the curve of age, BMI, operation time and GG in predicting perioperative blood transfusion in elderly patients with lower limb fracture were 0.629, 0.677, 0.637 and 0.774, respectively, among which GG had the best predictive value.Conclusion Blood glucose gap prediction of perioperative blood transfusion in elderly patients with lower extremity fracture may have good efficacy, and have advantages of easy access, simple calculation, and can provide reference for clinical identification of high blood transfusion population.
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表 1 输血组和未输血组临床资料比较
项目 输血组(n=38) 未输血组(n=123) χ2/t P 年龄/岁 78.58±8.85 72.73±6.95 4.239 < 0.001 性别/例(%) 男 9(23.68) 31(25.20) 0.036 0.850 女 29(76.32) 92(74.80) BMI/(kg/m2) 21.18±1.98 23.40±1.50 7.364 < 0.001 骨折部位/例(%) 股骨 17(44.74) 57(46.34) 0.101 0.992 股骨颈 7(18.42) 20(16.26) 胫腓骨 8(21.05) 26(21.14) 其他 6(15.79) 20(16.26) 合并基础病/例(%) 是 23(60.53) 72(58.54) 0.048 0.827 否 15(39.47) 51(41.46) ASA分级/例(%) Ⅰ级 6(15.79) 22(17.89) 7.788 0.020 Ⅱ级 21(55.26) 88(71.54) Ⅲ级 11(28.95) 13(10.57) 手术方式/例(%) 内固定术 27(71.05) 51(41.46) 10.181 0.002 关节置换术 11(28.95) 72(58.54) 手术时间/min 78.58±6.45 71.52±8.41 4.757 < 0.001 Hb/(g/L) 99.77±18.26 126.02±14.15 9.301 < 0.001 WBC/(×109/L) 9.01±1.69 9.52±2.50 1.176 0.241 PLT/(×109/L) 203.36±61.15 222.51±55.59 1.812 0.072 HCT 0.25±0.09 0.32±0.05 6.116 < 0.001 RDW 16.93±2.41 16.84±2.91 0.173 0.863 INR 0.89±0.20 0.88±0.24 0.233 0.816 PT/s 9.71±1.87 9.83±2.01 0.327 0.744 APTT/s 27.34±2.95 26.96±4.74 0.466 0.642 Fib/(g/L) 3.66±1.00 4.03±0.46 3.172 0.002 GG/(mmol/L) 2.29±0.91 0.25±0.10 24.555 < 0.001 
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表 2 影响老年下肢骨折患者围术期输血的多因素logistic回归分析
因素 β SE Ward χ2 P OR 95%CI 年龄 1.180 0.564 4.379 < 0.001 3.255 1.078~9.832 BMI 0.524 0.289 3.282 0.015 1.688 0.958~2.974 手术时间 0.583 0.363 2.582 0.039 1.792 0.880~3.650 Hb 1.244 0.335 13.787 < 0.001 3.469 1.799~6.689 GG 1.039 0.347 8.969 < 0.001 2.827 1.432~5.581
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表 3 GG预测老年下肢骨折患者围术期输血的ROC曲线分析结果
变量 AUC 95%CI P 最佳截断值 灵敏度 特异度 年龄 0.629 1.078~9.832 0.026 68岁 0.688 0.488 BMI 0.677 0.569~0.785 0.003 20.8 kg/m2 0.723 0.595 手术时间 0.637 0.524~0.751 2.582 67.2 min 0.709 0.581 GG 0.774 0.681~0.868 < 0.001 1.07 0.837 0.612
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