The Clinical Significance Of Combined Detection Of Three Peripheral Blood Indicators In Predicting The Cardiovascular And Cerebrovascular Complications After PFNA In Elderly Patients With Intertrochanteric Fractures

Objectives To explore the clinical significance of combined detection of three peripheral blood indicators in predicting the cardiovascular and cerebrovascular complications after PFNA in elderly patients with intertrochanteric fractures,and to provide a reference basis for clinical prediction of postoperative complications.Methods A total of 60 elderly patients ≥65 years of age who received intertrochanteric fractures and undergoing PFNA internal fixation surgery from January 2012 to October 2020 in our hospital were collected.They were divided into complication groups according to whether cardiovascular and cerebrovascular complications occured after the operation.(Observation group,n=30)and uncomplicated group(Control group,n=30).All patients were collected blood from the vein before the operation on the second day of admission for laboratory examination,including blood routine,urine routine,liver function,renal function,clotting time,blood type,D-dimer and infection.Imaging examinations include pelvic orthographic position,full-length femoral shaft orthographic and lateral position,three-dimensional CT of the affected hip joint,electrocardiogram,and chest film,etc.Comprehensively evaluate the clinical status of the patient before surgery,actively control related medical diseases,evaluate the risk of surgical anesthesia and formulate a reasonable anesthesia plan.Fully communicate with patients and their families before surgery,and explain in detail the purpose of the surgery,intraoperative and postoperative complications,prognosis,and various precautions,etc.Routine fasting for 8 hours before surgery,4 hours for water deprivation,routine use of antibiotics 30 minutes before surgery to prevent infection,postoperative observation and recording whether cardiovascular and cerebrovascular complications occurred.Univariate and multivariate Logistic regression methods were used to analyze the independent influencing factors of postoperative complications.The ROC curve method was used to analyze the optimal threshold,sensitivity and specificity of various indicators,and the preoperative laboratory examinations of the two groups of patients were compared and analyzed result.Result1.The values of RBC,PCV,HB,RDWSD,PLT,and PCT of the observation group were all smaller than those of the control group,and there were statistically significant differences(P < 0.05).There was no statistical difference in other indicators between the two groups(P>0.05).2.Compared with the control group,the observation group decreased ALB content.FBGC,CRP,and CRP/ALB ratio increased,and there were statistical differences(P<0.05).3.Univariate analysis results: CRP,RBC,PCV,HB,PLT,ALB,FBGC and CRP/ALB ratio are all factors related to postoperative complications.Multivariate analysis results: RBC,CRP and PLT are independent factors influencing postoperative complications.4.The AUC values of the area under the ROC curve for the detection of CRP,RBC and PLT alone and in combination are 0.732,0.722,0.655 and 0.830,respectively;the cut-off value of CRP is>18.23,the sensitivity is 60.00%,and the specificity is 76.67%;the cut-off value of RBC is ≤4.03,the sensitivity is 83.33%,the specificity is 50.00%;the cut-off value of PLT is>202,the sensitivity is 53.33%,the specificity is 86.67%;the sensitivity of the combined detection of the three indicators is 80.00%,the specificity is 73.33%.ConclusionPreoperative RBC,PLT and CRP are closely related to the occurrence of cardiovascular and cerebrovascular complications after PFNA.The combined detection of three indicators before surgery can provide a reference for predicting the occurrence of cardiovascular and cerebrovascular complications in elderly patients after PFNA.