老年髋部骨折患者术后发生肺部感染风险因素的Meta分析

Meta-analysis of risk factors for postoperative pulmonary infection in elderly patients with hip fractures

目的系统评价和分析老年髋部骨折患者术后发生肺部感染的风险因素。方法由2名研究者独立检索PubMed、Cochrarne Library、Web of Science、Embase、CINAHL、中国生物医学文献数据库、CNKI、维普、万方数据库中关于老年髋部骨折患者术后肺部感染风险因素的队列研究或病例对照研究,检索时限为建库至2020年6月15日。经文献筛选、文献质量评价及提取资料后利用RevMan 5.4软件进行Meta分析。结果共纳入17篇文献,其中中文文献11篇,英文文献6篇。Meta分析结果显示,男性、年龄≥75岁、手术等待时间>48 h、手术时间>2 h、全身麻醉、吸烟(史)、合并脑卒中、贫血、合并COPD、合并呼吸系统疾病、低蛋白血症、美国麻醉医师协会分级为Ⅲ或Ⅳ级、机械通气、血清维生素25(OH)D缺乏、入住ICU、合并糖尿病、术前合并症数量>3个、认知功能障碍、低功能状态是老年髋部骨折患者术后发生肺部感染的风险因素(P<0.05)。结论老年髋部骨折患者术后发生肺部感染受众多因素影响,建议组建多学科团队及时准确识别术后肺部感染的风险因素,并积极采取措施预防术后肺部感染的发生。

Objective To systematically evaluate and analyze the risk factors for postoperative pulmonary infection in elderly patients with hip fractures.Methods Two researchers independently searched PubMed,Cochrarne Library,Web of Science,Embase,CINAHL,Chinese Biomedical Literature Database,China National Knowledge Internet(CNKI),VIP,Wanfang database on the cohort or case-control studies on risk factors for postoperative lung infection in elderly patients with hip fracture hip fractures.The search time limit was from the establishment of the databases to June 15,2020.After literature screening,literature quality evaluation and data extraction,Meta-analysis was performed using RevMan 5.4 software.Results A total of 17 literatures were included,including 11 Chinese literatures and 6 English literatures.Meta-analysis results showed that male,age of 75 years or older,surgery waiting time greater than 48 hours,surgery time greater than 2 hours,general anesthesia,smoking(history),combination with stroke,anemia,combination with chronic obstructive pulmonary disease(COPD),combination with respiratory disease,hypoproteinemia,American Society of Anesthesiologists gradeⅢorⅣ,mechanical ventilation,serum vitamin 25(OH)D deficiency,admission to Intensive Care Unit,combination with diabetes mellitus,the number of preoperative complications greater than 3,cognitive dysfunction and low functional status were risk factors of postoperative lung infection in elderly patients with hip fractures(P<0.05).Conclusions The postoperative pulmonary infection in elderly patients with hip fractures is affected by many factors.It is suggested to establish a multidisciplinary team to timely and accurately identify risk factors of postoperative pulmonary infection and take active measures to prevent the occurrence of postoperative pulmonary infection.