老年髋部骨折围术期肺部感染危险因素分析

Risk factors for perioperative pulmonary infection in patients with senile hip fracture

背景:目前对于老年骨折治疗后肺部感染的研究少有报道,对于老年特殊部位,如髋部骨折后围术期肺部感染的并发症也无少见相关报道。目的:探讨老年髋部患者骨折患者围术期合并肺部感染的危险因素。方法:回顾性分析46例老年髋部骨折围术期合并肺部感染的病例资料,并随机选择同时期同一区域住院的未合并肺部感染的老年髋部骨折患者46例作为对照,比较两组患者围术期各临床指标的差异性,合并肺部感染的危险因素行Logistic回归多因素分析。结果与结论:单因素相关分析筛选出14个可能的围术期合并肺部感染相关因素,包括:慢性阻塞性肺病、吸烟、糖尿病、心脏疾病、机械通气、术中出血量、输注红细胞、手术时间、术前低体质量指数(体质量指数<18.5 kg/m2)、血清白蛋白<35 g/L、电解质紊乱、入住ICU及住院时间;Logistic多因素回归分析显示:慢性阻塞性肺病(OR=23.317;95%CI:2.702-60.312;P=0.000)、入住ICU(OR=7.890;95%CI:2.624-76.012;P=0.008)、机械通气(OR=35.210;95%CI:8.464-131.203;P=0.017)、手术时间(OR=12.122;95%CI:5.154-99.098;P=0.012)为老年髋部骨折患者围术期肺部感染的独立危险因素。说明老年髋部骨折患者存在慢性阻塞性肺病、入住ICU及机械通气等因素时应警惕发生肺部感染的可能。

BACKGROUND：At present, few studies concerned pulmonary infection after treatment of senile fracture. For special parts of senile patients, there are no studies on complications of pulmonary infection in perioperative period after hip fracture. OBJECTIVE：To study risk factors for pulmonary infection in patients with senile hip fractures in perioperative period. METHODS：The data of 46 senile hip fracture patients with perioperative pulmonary infection were retrospectively analyzed. A matched case-control study was conducted in 46 senile hip fracture patients without pulmonary infection in the same hospital and the same period. The difference in perioperative various clinical indexes was compared between the two groups. Risk factors of pulmonary infection received Logistic regression analysis. RESULTS AND CONCLUSION：Multivariate analysis screened out 14 possible perioperative pulmonary infection factors：chronic obstructive pulmonary disease, smoking, diabetes mel itus, heart disease, mechanical ventilation, intraoperative bleeding amount, erythrocyte infusion, operation time, preoperative low body mass index （body mass index〈18.5 kg/m2 ）, serum albumin〈35 g/L, electrolyte disturbance, time of entering intensive care unit and length of stay. Logistic regression analysis displayed that chronic obstructive pulmonary disease （OR=23.317;95%CI：2.702-60.312;P=0.000）, entering intensive care unit （OR=7.890;95%CI：2.624-76.012;P=0.008）, mechanical ventilation （OR=35.210;95%CI：8.464-131.203;P=0.017） and operation time （OR=12.122;95%CI：5.154-99.098;P=0.012） were independent risk factors for perioperative pulmonary infection in patients with senile hip fracture. These data indicated that one should be alert to the possible occurrence of pulmonary infection in senile hip fracture patients with the presence of chronic obstructive pulmonary disease, entering intensive care unit and mechanical ventilation.