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中华关节外科杂志(电子版)

中华关节外科杂志(电子版) ›› 2021, Vol. 15 ›› Issue (01) : 39 -44. doi: 10.3877/cma.j.issn.1674-134X.2021.01.007

所属专题： 文献；

临床论著

低蛋白血症延长髋膝关节置换患者住院日
徐兴全1, 闫文强1, 姚尧1, 严文津1, 郭虎1, 陈东阳1, 徐志宏1, 蒋青1, 史冬泉1,†()   
  1. 1. 210008　南京大学医学院附属鼓楼医院运动医学与成人重建外科
  • 收稿日期:2020-04-09 出版日期:2021-02-01
  • 通信作者: 史冬泉
  • 基金资助:
    江苏省自然科学基金青年项目(BK20180127); 国家自然科学基金青年项目(81802196)

Preoperative hypoproteinemia increases length of stay in patients undergoing primary knee or hip arthroplasty

Xingquan Xu1, Wenqiang Yan1, Yao Yao1, Wenjin Yan1, Hu Guo1, Dongyang Chen1, Zhihong Xu1, Qing Jiang1, Dongquan Shi1,†()   

  1. 1. Department of Sports Medicine and Adult Reconstructive Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
  • Received:2020-04-09 Published:2021-02-01
  • Corresponding author: Dongquan Shi
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徐兴全, 闫文强, 姚尧, 严文津, 郭虎, 陈东阳, 徐志宏, 蒋青, 史冬泉. 低蛋白血症延长髋膝关节置换患者住院日[J]. 中华关节外科杂志(电子版), 2021, 15(01): 39-44.

Xingquan Xu, Wenqiang Yan, Yao Yao, Wenjin Yan, Hu Guo, Dongyang Chen, Zhihong Xu, Qing Jiang, Dongquan Shi. Preoperative hypoproteinemia increases length of stay in patients undergoing primary knee or hip arthroplasty[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2021, 15(01): 39-44.

目的

探讨术前低蛋白血症和初次髋膝关节置换术住院时长的相关性。

方法

回顾性分析2017年8月至2019年1月在南京鼓楼医院运动医学与成人重建外科行初次人工关节置换术的患者资料，排除掉资料不全、围手术期对并发症进行过针对治疗、一期行双侧关节置换、行翻修手术、血友病性关节炎等病人，共纳入男253例，女640例，年龄范围19～95岁。初次髋关节置换492例，初次膝关节置换401例。根据血清白蛋白数值将患者分为低蛋白血症组和正常组。分别记录两组患者总住院天数、术前住院天数及术后住院天数并进行比较。记录两组患者术前伴随基础疾病状态、围手术期输血情况以及术后并发症发生情况。两组患者间定量资料行Mann-Whitney U检验；性别、关节置换类型、伴随疾病及术后并发症之间采用卡方检验。采用多因素线性回归分析研究影响总住院时间的因素。并研究术前低蛋白血症和住院时长增加的相关性。

结果

入选人群中低蛋白血症发生率43.6%，两组人群在性别、年龄、关节置换种类方面差异均无统计学意义(P>0.05)。低蛋白血症组总住院时长、术前住院时长及术后住院时长均显著长于正常组[(11.5±4.0)d vs (10.5±3.9)d，U＝78 375, P<0.001；(5.1±2.6)d vs (4.8±2.4)d，U＝88 193, P＝0.0093；(6.4±2.8)d vs (5.7±2.8)d，U＝76 023，P<0.001]。低蛋白血症组有更多比例的高血压病史、脑血栓病史以及手术史。两组患者在输血率及术后并发症方面差异均无统计学意义(均为P>0.05)。多元回归分析显示高龄、膝关节置换、脑血栓病史及低蛋白血症与住院时长显著相关。

结论

术前低蛋白血症可显著增加初次人工关节置换患者住院时长。

关键词: 低蛋白血症, 关节成形术, 住院时间
Objective

To evaluate the association between preoperative hypoalbuminemia and length of stay in patients undergoing primary knee or hip arthroplasty.

Methods

From August 2017 to January 2019, 253 male and 640 female patients who underwent primary knee or hip arthroplasty were enrolled in this retrospective study. The patients with incomplete information, perioperative serious complications for specific treatment, bilateral arthroplasty, revision surgery, and hemophiliac arthritis were excluded. The age ranged from 19 to 95 years old. There were 492 cases of primary knee arthroplasty and 401 cases of primary hip arthroplasty. The patients were divided into the hypoproteinemia and normal group according to the serum albumin level. The lengths of total, preoperative and postoperative hospital stay of the two groups were recorded. The preoperative morbidities, perioperative blood transfusion rate, and postoperative complications in the two groups were recorded. The quantitative data between the two groups were evaluated by Mann-Whitney U test. The chi-square test was used to analyze the difference of gender, type of joint replacement, concomitant diseases, and postoperative complications between the two groups. Multivariate linear regression was used to analyze the factors affecting the length of stay. The association between hypoproteinemia and increase of length of stay was analyzed.

Results

The total incidence of hypoproteinemia was 43.6%.There was no statistically significant difference in gender, age, or joint replacement type between the two groups (P>0.05). The total, preoperative, and postoperative lengths of stay in the hypoproteinemia group were significantly longer than those in the normal group [(11.5±4.0) d vs (10.5±3.9)d, U=78 375, P<0.001; (5.1±2.6)d vs (4.8±2.4)d, U=88 193, P<0.01; (6.4±2.8)d vs (5.7±2.8)d, U=76 023, , P<0.001]. The patients in hypoproteinemia group had a significantly higher proportion of hypertension, cerebral thrombosis and surgical history. There was no statistically significant difference in blood transfusion rate and postoperative complications between the two groups(all P>0.05). Multiple regression analysis showed that age, knee arthroplasty, history of cerebral thrombosis and hypoproteinemia were significantly correlated with length of stay.

Conclusion

Preoperative hypoproteinemia could significantly increase the length of stay in patients undergoing primary knee or hip arthroplasty.

Key words: Hypoproteinemia, Arthroplasty, Length of stay
表1 低蛋白血症组与正常组患者基本人口学特征的比较
组别 例数 年龄[岁，M(P25，P75)] 性别(男/女) 关节置换种类(膝/髋)
低蛋白血症组 389 68(61，74) 117/272 187/202
正常组 504 66(60，75) 136/368 214/290
统计值   U＝96 985 χ2＝1.034 χ2＝2.795
P值   >0.05 >0.05 >0.05
表2 低蛋白血症组和正常组患者转时长的比较[d，M(P25，P75)]
组别 例数 总住院时长 术前住院时长 术后住院时长
低蛋白血症组 389 11(9，13) 5(3，6) 6(5，7)
正常组 504 10(8，12) 4(3，6) 5(4，6)
U值   78 375 88 193 76 023
P值   <0.001 <0.01 <0.001
表3 低蛋白血症组与正常组患者围手术期资料比较[例(%)]
项目 低蛋白血症组 正常组 χ2值 P值
例数 389 504    
糖尿病史 72(18.51) 77(15.28) 1.649 >0.05
高血压病史 202(51.93) 216(42.86) 7.255 <0.01
肿瘤史 15(3.86) 21(4.17) 0.055 >0.05
心血管疾病史 60(15.42) 76(15.08) 0.020 >0.05
脑血栓病史 64(16.45) 38(7.54) 17.24 <0.001
手术史 88(22.62) 152(30.16) 6.345 >0.05
术前贫血 85(21.85) 98(19.44) 0.780 >0.05
超重 50(12.85) 51(10.12) 1.637 >0.05
围手术期输血 47(12.08) 44(8.73) 2.696 >0.05
术后血栓形成 60(15.42) 68(13.49) 0.668 >0.05
术后切口感染 1(0.26) 2(0.40) 0.1281 >0.05
表4 分类变量哑变量赋值表
因素 变量名 赋值说明 因素 变量名 赋值说明
性别 x1 女＝1，男＝0 脑血栓病史 x6 有＝1，无＝2
手术类型 x2 膝置换＝1，髋关节＝2 手术史 x7 有＝1，无＝2
糖尿病史 x3 有＝1，无＝2 术前贫血 x8 有＝1，无＝2
高血压病史 x4 有＝1，无＝2 超重 x9 有＝1，无＝2
心血管疾病史 x5 有＝1，无＝2 低蛋白血症 x10 有＝1，无＝2
表5 住院时长影响因素的多元线性回归分析
因素 回归系数 标准误 标准化回归系数 t值 P值
(常量) 5.451 0.639 - 8.537 <0.001
年龄 0.063 0.010 0.221 6.588 <0.001
性别(女) 0.395 0.302 0.043 1.305 0.192
手术类型(膝vs.髋置换) 1.162 0.279 0.140 4.166 <0.001
糖尿病史 -0.577 0.363 -0.052 -1.588 0.113
高血压病史 -0.279 0.284 -0.034 -0.983 0.326
肿瘤史 -0.759 0.676 -0.036 -1.123 0.262
心血管疾病史 0.224 0.370 0.019 0.605 0.545
脑血栓病史 0.927 0.433 0.071 2.142 0.032
手术史 -0.160 0.297 -0.017 -0.541 0.589
术前贫血 0.377 0.335 0.037 1.128 0.260
超重 -0.117 0.430 -0.009 -0.271 0.786
低蛋白血症 1.176 0.268 0.141 4.380 <0.001
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