Abstract:

Objective To explore the current status of bone metabolism abnormalities after lung transplantation and its influencing factors，and provide scientific references for the formulation of nursing intervention measures. Methods A retrospective analysis of the clinical data of 125 patients undergoing lung transplantation at a lung transplant center from June 2021 to August 2023 was conducted. The paired sample t-test was used to compare the trends in bone mineral density（BMD） before and after transplantation. Postoperative BMD was compared to domestic age-matched norms using the single sample t-test. Univariate analysis and unordered multinomial logistic regression were employed to identify factors associated with bone metabolism abnormalities post-transplantation. Results The incidence of bone metabolism abnormalities after lung transplantation was 62.4%，with osteopenia and osteoporosis rates at 36.8% and 25.6%，respectively. The BMD of the femoral neck and left hip joint generally showed a declining trend post-transplantation（P<0.001）. Additionally，both male and female patients had lower BMD than the age-matched national norms（P<0.001）. Logistic regression analysis indicated that pre-transplant Activities of Daily Living（ADL） score was a significant factor for post-transplant osteopenia（OR 0.957，95%CI 0.928~0.987）. Female gender，pre-transplant low body weight，obesity，reduced forced expiratory volume in one second/forced vital capacity percentage（FEV1/FVC），and ADL score were significant factors for post-transplant osteoporosis，with OR values of 7.181，7.521，15.465，0.960，0.964；95%CI were 1.287~40.061，2.039~27.738，1.158~206.586，0.937~0.983，0.930~0.999，respectively. Conclusion Bone metabolism abnormalities are common in patients post-lung transplantation. Healthcare providers should pay particular attention to female patients，those with low pre-transplant body weight，obesity，reduced FEV1/FVC，and lower ADL scores. Timely，individualized，and multidisciplinary interventions are crucial to slowing postoperative bone loss，reducing the incidence of bone metabolism abnormalities，and improving the health-related quality of life for these patients.

Key words: Lung Transplantation, Bone Metabolism, Root Cause Analysis, Nursing Care

摘要：

目的 探究肺移植后患者骨代谢异常发生现状及其影响因素，为制订护理干预措施提供参考依据。方法 回顾性分析2021年6月—2023年8月浙江省某三级甲等综合医院肺移植中心125例肺移植患者的临床资料，使用配对样本t检验比较移植前后骨密度变化趋势，术后骨密度与国内同龄人群骨密度常模比较采用单样本t检验，使用单因素分析和无序多分类Logistic回归分析探究肺移植后骨代谢异常相关影响因素。结果 肺移植后骨代谢异常发生率为62.4%，其中，低骨量、骨质疏松症发生率分别为36.8%、25.6%；股骨颈、左侧髋关节骨密度较移植前呈下降趋势（P<0.001）；且男性与女性患者骨密度均低于国内同龄人群骨密度常模（P<0.001）；Logistic回归分析显示，以骨量正常组为对照，移植前日常生活活动能力评分是肺移植后低骨量的影响因素（OR值为0.957，95%CI为0.928~0.987）；女性以及移植前低体重、肥胖、第1秒用力呼气量占用力肺活量百分率（forced expiratory volume in one second/forced vital capacity percentage，FEV1/FVC）、日常生活活动能力评分是骨质疏松症的影响因素，OR值分别为7.181、7.521、15.465、0.960、0.964，95%CI分别为1.287~40.061、2.039~27.738、1.158~206.586、0.937~0.983、0.930~0.999。结论 肺移植后患者骨代谢异常现象较为普遍，医护人员应重点关注女性、移植前低体重、肥胖、FEV1/FVC降低以及日常生活活动能力评分偏低的患者，及时采取个性化、多学科干预措施，延缓患者术后骨质流失速率，降低骨代谢异常发生率，提高患者健康相关生活质量。

关键词: 肺移植, 骨代谢, 影响因素分析, 护理