老年髋关节骨折患者术后下呼吸道微生物定植及其与肺部感染的关系

Relationship between postoperative colonization of lower respiratory tract mic- roorganisms and pulmonary infection in elderly patients with hip fractures

目的分析老年髋关节骨折患者术后下呼吸道微生物定植与肺部感染的关系。方法选取2017年10月-2020年10月湖北省中医院收治的老年髋关节骨折患者200例作为研究对象,均随访1个月。测下呼吸道微生物定植情况和血清降钙素原(PCT)、超敏C-反应蛋白(hs-CRP)和白细胞介素-8(IL-8)水平,统计随访1个月后的肺部感染情况,分析老年髋关节骨折患者术后下呼吸道微生物定植与肺部感染的相关性。结果老年髋关节骨折患者肺部感染的发生率为8.00%(16/200)。200例老年髋关节骨折患者中痰菌定量≥10^(7) CFU/ml有58例,定植率29.00%;下呼吸道微生物定植患者的血清PCT、hs-CRP、IL-8水平和肺部感染发生率高于非定植患者(P<0.05)。肺部感染组16例患者痰标本共检出下呼吸道定植菌28株,其中革兰阴性菌18株占64.29%,以肺炎克雷伯菌、铜绿假单胞菌、大肠埃希菌为主;革兰阳性菌9株32.14%,以肺炎链球菌为主;真菌1株占3.57%。肺部感染组患者的下呼吸道定植发生率和血清PCT、hs-CRP、IL-8均高于非感染组(P<0.05)。老年髋关节骨折患者肺部感染与血清PCT、hs-CRP、IL-8水平和下呼吸道微生物定植均呈正相关性(P<0.05)。结论老年髋关节骨折术后肺部感染患者下呼吸道微生物定植发生率较高,其定植菌以革兰阴性菌为主,下呼吸道微生物定植可能通过加重气道炎症反应等增加老年髋关节骨折术后肺部感染的发生率。

OBJECTIVE To analyze the relationship between postoperative colonization of lower respiratory tract microorganisms and pulmonary infection in elderly patients with hip fractures.METHODS A total of 200 elderly patients with hip fractures admitted to Hubei Provincial Hospital of Traditional Chinese Medicine from Oct.2017 to Oct.2020 were selected as the research subjects,and all were followed up for 1 month.The colonization of lower respiratory tract microorganisms,levels of serum procalcitonin(PCT),high-sensitivity C-reactive protein(hs-CRP) and interleukin-8(IL-8) were detected.The incidence of pulmonary infection after 1 month of follow-up was statistically analyzed,and the correlation between postoperative colonization of lower respiratory tract microorganisms and pulmonary infection in elderly patients with hip fractures was analyzed.RESULTS The incidence of lung infection in elderly patients with hip fractures was 8.00%(16/200).Among the 200 elderly patients with hip fractures,there were 58 cases with sputum quantification not lower than 10^(7)CFU/ml,and the colonization rate was 29.00%.The levels of serum PCT,hs-CRP and IL-8,and incidence of lung infection in patients with colonization of lower respiratory tract microorganisms were significantly higher than those without colonization(P<0.05).A total of 28 strains of lower respiratory tract colonization bacteria in the sputum specimens of 16 patients in infection group,of which 18 strains of Gram-negative bacteria accounted for 64.29%,mainly Klebsiella pneumonia,Pseudomonas aeruginosa and Escherichia coli,9 strains of Gram-positive bacteria accounted for 32.14%,mainly Streptococcus pneumoniae,and 1 strains of fungi accounted for 3.57%.The incidence of lower respiratory tract colonization,levels of serum PCT,hs-CRP and IL-8 in the lung infection group were significantly higher than those in the non-infection group(P<0.05).The lung infection was positively correlated with levels of serum PCT,hs-CRP and IL-8,and colonization of lower respiratory tract microorganisms in elderly patients with hip fracture(P<0.05).CONCLUSION The incidence of lower respiratory tract microbial colonization in elderly patients with lung infection after hip fracture surgery was relatively higher.The colonization bacteria were mainly Gram-negative bacteria.The colonization of lower respiratory tract microorganisms might increase the incidence of postoperative lung infection in the elderly with hip fractures by aggravating airway inflammation response.