心率变异性与老年髋部骨折病人术后感染的相关性

doi:10.3969/j.issn.1003-9198.2021.05.007

摘要/Abstract

摘要： 目的探讨心率变异性与老年髋部骨折病人术后感染的相关性。方法选取2018 年1月至2020 年4月在我院住院接受手术治疗的髋部骨折老年病人171例,根据术后7 d内是否发生感染分为感染组(n=33)和非感染组(n=138),比较2组病人基本情况、血生化指标、总功率(TP)、低频功率(LF)、极低频功率(VLF)、LF与高频功率(HF)的比值(LF/HF)、心跳间期的标准差(SDNN)等方面的差异。采用多因素Logistic回归分析探讨心率变异性与老年髋部骨折病人术后感染的相关性。结果感染组病人年龄及伴糖尿病比例明显高于非感染组(P<0.05)。与非感染组比较,感染组病人VLF及LF/HF水平明显降低(P<0.01)。多因素Logistic回归分析结果显示,VLF(OR=0.986,95%CI:0.976～0.997,P=0.012)及LF/HF(OR=0.416,95%CI:0.259～0.667,P<0.001)为老年髋部骨折病人术后感染的独立影响因素。LF/HF预测老年髋部骨折病人术后感染的AUC明显大于VLF(0.819比0.679, Z=2.227,P=0.026)。当LF/HF的最佳临界值为0.91时,其预测老年髋部骨折病人术后感染的灵敏度为60.6％,特异度为89.4%。结论 VLF及LF/HF为老年髋部骨折病人术后感染的独立影响因素,LF/HF可作为评估老年髋部骨折病人术后感染的较好指标。

关键词: 心率变异性, 髋部骨折, 术后感染, 相关性, 老年人

Abstract: Objective To explore the correlation between heart rate variability (HRV) and postoperative infection in the elderly patients with hip fracture. Methods A total of 171 elderly patients with hip fractures admitted to our hospital for surgery from January 2018 to April 2020 were selected and divided into infection group (n=33) and non-infection group (n=138) according to whether there were infected within 7 d after operation.The differences between the two groups in basic conditions, blood biochemical indexes, and total power (TP), low frequency power (LF), very low frequency power (VLF), ratio of LF to high frequency power (LF/HF), standard deviation of R-R interval (SDNN) of HRV were compared. Multi-Logistic regression analysis was used to explore the correlation between HRV and postoperative infection in the elderly patients with hip fracture. Results The age and the proportion of diabetes mellitus in infection group were significantly higher than those in non-infection group (P<0.05). Compared with non-infection group, the levels of VLF and LF/HF in infection group were significantly lower (P<0.01). Multi-Logistic regression analysis showed that VLF (OR=0.986, 95%CI:0.976-0.997, P=0.012) and LF/HF (OR=0.416, 95%CI: 0.259-0.667, P<0.002) were independent influencing factors for postoperative infection in the elderly patients with hip fracture. The area under ROC curve (AUC) of LF/HF for predicting postoperative infection in the patients with hip fracture was significantly greater than that of VLF(0.819 vs 0.679, Z=2.227,P=0.026). The optimal cutoff value of LF/HF was 0.91,which showed a sensitivity of 60.6% and a specificity of 89.4% for the prediction of postoperative infection in the elderly patients with hip fracture. Conclusions The levels of VLF and LF/HF are closely related to postoperative infection in the elderly patients with hip fracture, and LF/HF can be a better indicator for evaluating postoperative infection in the elderly patients with hip fracture.

Key words: heart rate variability, hip fracture, postoperative infection, correlation, aged

中图分类号:

R 687.3
R 63

黄泽晓, 邢柏. 心率变异性与老年髋部骨折病人术后感染的相关性[J]. 实用老年医学, 2021, 35(5): 459-462.

HUANG Ze-xiao, XING Bo. Correlation between heart rate variability and postoperative infection in elderly patients with hip fracture[J]. Practical Geriatrics, 2021, 35(5): 459-462.

参考文献

[1] LV H, YIN P, LONG A, et al. Clinical characteristics and risk factors of postoperative pneumonia after hip fracture surgery: a prospective cohort study[J]. Osteoporos Int, 2016, 27(10): 3001-3009.
[2] BYUN S E, SHON H C, KIM J W, et al. Risk factors and prognostic implications of aspiration pneumonia in older hip fracture patients: A multicenter retrospective analysis[J]. Geriatr Gerontol Int, 2019, 19(2): 119-123.
[3] BOHL D D, IANTORNO S E, SALTZMAN B M, et al. Sepsis within 30 days of geriatric hip fracture surgery[J]. J Arthroplasty, 2017, 32(10): 3114-3119.
[4] BARNABY D P, FERNANDO S M, FERRICK K J, et al. Use of the low-frequency/high-frequency ratio of heart rate variability to predict short-term deterioration in emergency department patients with sepsis[J]. Emerg Med J, 2018, 35(2): 96-102.
[5] 李立新,陈贵发,张翠宏.心率变异性在预测脑卒中后感染的应用价值[J].中国老年学杂志,2020,40(3):483-485.
[6] 薄天慧,陈勇,韩黎,等.中美医院感染诊断标准在某医院感染现患率调查中应用对比分析[J].中国消毒学杂志,2019,36(5):374-376.
[7] BOHL D D, SERSHON R A, SALTZMAN B M, et al. Incidence, risk factors, and clinical implications of pneumonia after surgery for geriatric hip fracture[J]. J Arthroplasty, 2018, 33(5): 1552-1556.e1.
[8] 徐爱花,王琨,滕云.骨科护理人员糖尿病知识掌握程度对糖尿病骨折患者术后感染的影响[J].齐鲁护理杂志,2019,25(14):104-106.
[9] FOURADOULAS M, VON KANEL R, SCHMID J P. Heart rate variability - state of research and clinical applicability[J]. Praxis (Bern 1994), 2019, 108(7): 461-468.
[10]BRAMER D, GUNTHER A, RUPPRECHT S, et al. Very low frequency heart rate variability predicts the development of post-stroke infections[J]. Transl Stroke Res, 2019, 10(6): 607-619.

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