股骨颈骨折患者术前白蛋白水平与术后低氧血症风险的关系:基于限制性立方样条及阈值效应研究-东南大学学报医学版

股骨颈骨折患者术前白蛋白水平与术后低氧血症风险的关系:基于限制性立方样条及阈值效应研究

单位：徐州医科大学附属淮安医院/淮安市第二人民医院骨科, 江苏淮安 223003

分类号：R683.42

出版年·卷·期（页码）：2026·45·第一期（34-43）

摘要：

目的:探究股骨颈骨折患者术前白蛋白与全髋关节置换术后低氧血症风险的关系。方法:便利抽样法选取2022年5月至2024年9月在本院行全髋关节置换术的股骨颈骨折患者。根据术后24 h内有无发生低氧血症分为低氧血症组和非低氧血症组。采用Logistic回归分析术后发生低氧血症的影响因素,并通过调整不同变量的Logistic回归分析术前白蛋白对术后低氧血症的独立影响关系;限制性立方样条(RCS)分析术前白蛋白与术后低氧血症的剂量反应关系;阈值效应分析术前白蛋白对术后低氧血症的量化影响。结果:最终纳入210例患者,术后发生低氧血症者51例(24.29%)。低氧血症组患者体质量指数(BMI)、高血压、术前白蛋白、围术期低体温与非低氧血症组比较,差异有统计学意义(均P<0.05)。多因素Logistic回归显示,BMI≥28.0 kg·m^-2(OR=9.063,95%CI:1.224~67.132)、高血压(OR=3.355,95% CI:1.379~8.162)、围术期低体温(OR=3.616,95% CI:1.076~12.156)是术后低氧血症的危险因素(均P<0.05),而术前白蛋白升高(OR=0.837,95% CI:0.777~0.902)是保护因素(P<0.05)。为进一步明确术前白蛋白的独立影响性,最终调整全部变量进行Logistic回归分析显示,术前白蛋白(OR=0.811,95% CI:0.746~0.882)仍独立影响术后低氧血症(P<0.001)。RCS曲线显示,调整全部变量后,术前白蛋白与术后低氧血症之间仍然存在非线性关系(P_{for overall}<0.001,P_{for nonlinear}=0.009)。阈值效应分析显示,术前白蛋白影响术后低氧血症的拐点为36.2 g·L^-1,当术前白蛋白水平<36.2 g·L^-1时,白蛋白每降低一个单位,股骨颈骨折患者术后发生低氧血症的风险增加2.427倍(OR=0.412,95% CI:0.285~0.596,P<0.05)。结论:术前白蛋白与BMI、高血压、围术期低体温共同影响股骨颈骨折患者全髋关节置换术后低氧血症,且术前白蛋白对术后低氧血症的影响不受其他变量干扰,具有独立影响性;术前白蛋白水平<36.2 g·L^-1时,随白蛋白水平降低,术后发生低氧血症的风险明显增高。

Objective: To investigate the relationship between preoperative albumin and postoperative hypoxemia following total hip replacement in patients with femoral neck fracture. Methods: A total of 210 patients with femoral neck fracture who underwent total hip replacement in our hospital from May 2022 to September 2024 were selected by convenient sampling method. The patients were divided into the hypoxemia group and the non-hypoxemia group based on whether hypoxemia occurred within 24 hours after the operation. Logistic regression was used to analyze the influencing factors of postoperative hypoxemia, and the independent association between preoperative albumin and postoperative hypoxemia was evaluated via Logistic regression models with different covariate adjustments. The dose-response relationship between preoperative albumin and postoperative hypoxemia was analyzed with restricted cubic spline(RCS). Threshold effect analysis was performed to quantify the impact of preoperative albumin on postoperative hypoxemia. Results: Finally, 210 patients were included, and 51 patients(24.29%) experienced postoperative hypoxemia. There were significant differences in body mass index(BMI), hypertension, preoperative albumin and perioperative hypothermia between the hypoxemia group and the non-hypoxemia group(all P<0.05). Multivariate Logistic regression showed that BMI≥28.0 kg·m^-2(OR=9.063, 95%CI:1.224-67.132), hypertension(OR=3.355, 95%CI:1.379-8.162), perioperative hypothermia(OR=3.616, 95%CI:1.076-12.156) were risk factors for postoperative hypoxemia(all P<0.05), while preoperative albumin elevation(OR=0.837, 95%CI:0.777-0.902) was a protective factor(P<0.05). In order to further clarify the independent effect of preoperative albumin, Logistic regression analysis adjusted for all variables showed that preoperative albumin(OR=0.811, 95% CI:0.746-0.882) still independently affected postoperative hypoxemia(P<0.001). RCS curve showed that after adjusting all variables, there was still a nonlinear relationship between preoperative albumin and postoperative hypoxemia(P_{for overall}<0.001, P_{for nonlinear}=0.009). Threshold effect analysis showed that the turning point of preoperative albumin influence on postoperative hypoxemia was 36.2 g·L^-1. When the preoperative albumin level was<36.2 g·L^-1, the risk of postoperative hypoxemia in patients with femoral neck fracture increased by 2.427 folds for each 1 g·L^-1 decrease in albumin(OR=0.412, 95% CI:0.285-0.596, P<0.05). Conclusion: Preoperative albumin, BMI, hypertension and perioperative hypothermia can jointly influence hypoxemia after total hip replacement in patients with femoral neck fracture, and the effect of preoperative albumin on postoperative hypoxemia is independent of other variables. When the preoperative albumin level was less than 36.2 g·L^-1, the risk of postoperative hypoxemia was significantly increased with the decrease of albumin level.

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