加速康复背景下老年髋部骨折患者围手术期医院感染的影响因素分析

Analysis on influencing factors of perioperative nosocomial infection in elderly patients with hip fracture under the background of enhance recovery after surgery

目的探讨加速康复背景下老年髋部骨折住院患者围手术期发生医院感染的影响因素,为骨科临床医院感染预防及控制提供参考依据。方法采用回顾性调查研究,收集2018年1月至2019年8月天津市天津医院实施加速康复项目后住院治疗的1628例老年髋部骨折患者的临床资料,通过查阅医院病历管理系统,对患者的社会人口学资料、病情资料和医院感染等相关资料进行回顾性调查及统计分析,采用多因素Logistic回归模型分析老年髋部骨折住院患者围手术期发生医院感染的影响因素。结果1628例老年髋部骨折患者围手术期发生医院感染102例,125例次,感染率为6.27%(102/1628),例次感染率为7.68%(125/1628),以下呼吸道感染为主,其次为泌尿道感染和手术部位感染,分别占72.80%(91/125)、11.20%(14/125)、10.40%(13/125);Logistic多因素回归分析显示:骨牵引(OR值为2.152,95%CI 1.130~4.097)、手术(OR值为0.268,95%CI 0.133~0.537)、住院天数≥15 d(OR值为12.123,95%CI 6.017~24.426)、留置尿管(OR值为7.566,95%CI 4.093~13.986)、心功能不全(OR值为2.112,95%CI 1.192~3.740)、电解质紊乱(OR值为2.383,95%CI 1.396~4.067)、下肢动脉硬化闭塞症(OR值为2.540,95%CI 1.279~5.045)和老年痴呆(OR值为3.673,95%CI 1.670~8.082)是与医院感染相关的影响因素(均P<0.05),手术能够降低患者发生医院感染的风险。结论老年髋部骨折患者围手术期发生医院感染的主要影响因素为骨牵引、手术、住院天数、留置尿管及并存疾病。在骨科临床应用加速康复外科理念,全面优化围手术期的管理,实施有效的医院感染防控措施,能够降低患者发生医院感染的风险。

Objective To analyze the influencing factors of perioperative nosocomial infection in elderly patients with hip fracture under the background of enhance recovery after surgery so as to provide guidance for prevention and control of the nosocomial infection.Methods The clinical data were collected from 1628 elderly patients with hip fracture who were hospitalized from January 2018 to August 2019,during the implementation of enhance recovery after surgery in Tianjin hospital.Medical records of the patients were reviewed and statistically analyzed through hospital medical record system,the incidence of perioperative nosocomial infection and the influencing factors for the infection were observed.Results Of the 1628 hospitalized patients with hip fracture,102 had nosocomial infection,125 case-times,with the infection rate 6.27%(102/1628)and the case-times infection rate 7.68%(125/1628).Lower respiratory tract,urinary tract and surgical site were the dominant infection sites,accounting for 72.80%(91/125),11.20%(14/125)and 10.40%(13/125)respectively.Univariate analysis and multivariate logistic regression analysis indicated that bone traction(OR value was 2.152,95%CI 1.130-4.097),surgery(OR value was 0.268,95%CI 0.133-0.537),hospitalization days≥15 d(OR value was 12.123,95%CI 6.017-24.426),indwelling urinary catheter(OR value was 7.566,95%CI 4.093-13.986),cardiac insufficiency(OR value was 2.112,95%CI 1.192-3.740),electrolyte disturbance(OR value was 2.383,95%CI 1.396-4.067),lower extremity arteriosclerosis obliterans(OR value was 2.540,95%CI 1.279-5.045)and senile dementia(OR value was 3.673,95%CI 1.670-8.082)were the influencing factors for the perioperative nosocomial infection.Conclusions The main influencing factors of nosocomial infection in elderly patients with hip fracture during the perioperative period were bone traction,operation,length of stay,indwelling urinary catheter and coexisting diseases.The risk of nosocomial infection can be reduced by applying the concept of enhance recovery after surgery in clinical orthopedics,comprehensively optimizing perioperative management and implementing effective prevention and control measures of nosocomial infection.