髋关节骨折急诊术后切口感染危险因素

Risk factors for postoperative incision infection in hip fracture patients undergoing emergency surgery

目的分析髋关节骨折急诊术后切口感染危险因素。方法以2017年7月-2020年2月金华市中心医院急诊医学中心收治的90例髋关节骨折患者为研究对象,根据术后是否发生感染分为感染组(n=32)和未感染组(n=58)。比较两组基本资料、手术相关指标、感染相关指标水平,并采用多因素Logistic回归分析髋关节骨折急诊术后切口感染的危险因素。结果感染组手术时间、清创时间、住院时间均长于未感染组,Ⅱ类切口类型例数多于未感染组(P<0.05)。感染后2 d,感染组血清白细胞介素-1β(IL-1β)水平、C-反应蛋白/白蛋白(CRP/Alb)、全血中性粒细胞与淋巴细胞比值(NLR)水平高于未感染组(P<0.05)。多因素Logistic回归分析结果显示,手术时间、血清IL-1β水平、全血NLR水平较高均为髋关节骨折急诊术后切口感染的独立危险因素(P<0.05)。结论髋关节骨折急诊术后患者发生感染会引起血清IL-1β水平、CRP/Alb、全血NLR水平升高,手术时间、清创时间、住院时间较长和切口类型Ⅱ类、血清IL-1β、CRP/Alb、NLR水平较高均为髋关节骨折急诊术后切口感染的危险因素,可据此对患者进行针对性护理和治疗,从而降低髋关节骨折急诊术后患者发生感染的概率。

OBJECTIVE To analyze the risk factors for postoperative incision infection in the hip fracture patients undergoing emergency surgery.METHODS A total of 90 patients with hip fracture who were treated in emergency medical center of Jinhua Central Hospital from Jul 2017 to Feb 2020 were recruited as the study subjects and divided into the infection group with 32 cases and the non-infection group with 58 cases according to the status of postoperative infection.The baseline data,surgery-related indexes and infection-related indexes were compared between the two groups,and multivariate logistic regression analysis was performed for the risk factors for the postoperative incision infection in the hip fracture patients undergoing emergency surgery.RESULTS The operation duration,time of debridement and length of hospital stay were significantly longer in the infection group than in the non-infection group,the patients with typeⅡincision were significantly more in the infection group than in the non-infection group(P<0.05).The serum interleukin-1β(IL-1β)level,C-reactive protein/albumin(CRP/Alb)and whole blood neutrophil to lymphocyte ratio(NLR)of the infection group were significantly higher than those of the non-infection group after the infection for 2 days(P<0.05).Multivariate logistic regression analysis showed that long operation duration and high levels of serum IL-1βand whole blood NLR were the independent risk factors for the postoperative incision infection in the hip fracture patients undergoing emergency surgery(P<0.05).CONCLUSION The postoperative infection in the hip fracture patients undergoing emergency surgery may lead to the rise of serum IL-1βlevel,CRP/Alb and whole blood NLR.Long operation duration,long time of debridement,long length of hospital stay,typeⅡincision,high levels of serum IL-1β,CRP/Alb and NLR are the independent risk factors for the postoperative incision infection in the hip fracture patients undergoing emergency surgery.It is necessary to carry out targeted nursing and treatment for such group of patients so as to reduce the incidence of postoperative infection in the hip fracture patients.