老年髋部骨折术后肺部感染发生的危险因素及预后分析

Risk factors and prognosis of pulmonary infection after hip fracture surgery of the elderly

目的探讨老年髋部骨折术后 30 天内肺部感染发生的相关危险因素,研究肺部感染对髋部骨折患者术后死亡风险的影响。方法回顾性分析我院 2012 年 1 月至 2016 年 12 月髋部骨折患者资料,根据术后 30 天内是否发生肺部感染,将患者分为肺部感染组和无肺部感染组,符合入选标准的髋部骨折患者1004 例,其中肺部感染组 131 例 (13.0%),无肺部感染组 873 例 (87.0%)。平均年龄 (80.01±8.14) 岁,男 / 女比例为 329 / 675,股骨转子间骨折 584 例,股骨颈骨折 420 例。术前合并症主要有高血压 590 例 (58.8%)、冠心病 266 例 (26.5%)、糖尿病 272 例 (27.1%)、痴呆 79 例 (7.9%)、脑卒中 359 例 (35.8%)、肾功能不全57 例 (5.7%)。通过多因素 Logistic 回归分析研究髋部骨折术后 30 天肺部感染发生的危险因素,比较肺部感染组与无肺部感染组患者术后 30 天、6 个月及总体病死率。结果高龄 (OR=1.063,95% CI=1.033~1.093)、延期手术 (OR=1.799,95% CI=1.037~3.120)、合并症数量≥ 4 (OR=4.929,95% CI=2.952~8.228) 是术后 30 天内肺部感染发生的独立危险因素。平均随访时间为 (27.28±16.70) 个月,肺部感染组术后 30 天、6 个月、总体病死率分别为 9.9% (13)、15.3% (20)、34.4% (45),而无肺部感染组患者术后 30 天、6 个月、总体病死率分别为 3.4% (30)、9.0% (79)、28.5% (249),两组相比,术后 30 天、6 个月病死率差异有统计学意义 (术后 30 天,P=0.001;术后 6 个月,P=0.026),术后总体病死率差异无统计学意义 (P=0.172)。结论髋部骨折术后肺部感染发生率高,其病死率远远高于无肺部感染患者,高龄、合并症数量≥ 4、延期手术是术后 30 天内肺部感染发生的独立危险因素。

Objective To explore risk factors of pulmonary infection within 30 days after hip fracture operation in the elderly,and to study its impact on mortality.Methods Clinical data from January 2012 to December 2016 were retrospectively analyzed.According to the occurrence of pulmonary infection within 30 days after operation or not,all 1004 patients were divided into pulmonary infection group (n=131,13.0%) and non-pulmonary infection group (n=873,87.0%).The mean age was (80.01±8.14) years,and male / female ratio was 329 / 675.584 patients were of intertrochanteric fractures and 420 patients were of femoral neck fractures.Preoperative comorbidities:590 cases of hypertension (58.8%),266 cases of coronary heart disease (26.5%),272 cases of diabetes mellitus (27.1%),79 cases of dementia (7.9%),359 cases of stroke (35.8%),57 cases of renal insufficiency (5.7%).Multivariate logistic regression analysis was used to study the risk factors of pulmonary infection within 30 days after hip fracture surgery.Overall mortality,mortalities 30 days and 6 months postoperatively were compared between the 2 groups.Results Advanced age (OR=1.063,95% CI=1.033-1.093),delayed operation (OR=1.799,95% CI=1.037-3.120),and the number of comorbidities (≥ 4) (OR=4.929,95% CI=2.952-8.228) were independent risk factors of pulmonary infection within 30 days after operation.The mean follow-up was (27.28±16.70) months.Mortalities of 30 days,6 months after operation and overall were 9.9% (13),15.3% (20),34.4% (45) in the pulmonary infection group,while 3.4% (30),9.0% (79),28.5% (249) in the non-pulmonary infection group.Mortalities of 30 days and 6 months after operation in pulmonary infection group were significantly higher than that of non-pulmonary infection group (30 days,P=0.001;6 months,P=0.026).There were no significant differences in overall mortality between the 2 groups (P=0.172).Conclusions High incidence of pulmonary infection after hip fracture surgery brings higher mortality rate.Advanced age,the number of comorbidities (≥ 4),and delayed operation are independent risk factors of pulmonary infection within 30 days after operation.