老年髋部骨折术后肺炎影响因素分析

Influence factors of postoperative pneumonia in elderly patients with hip fracture

目的:探讨老年髋部骨折术后肺炎影响因素,为临床医师预防此类并发症提供参考。方法:回顾性分析2020年1月至2022年3月收治的1204例年龄≥65岁的老年髋部骨折患者。患者年龄、性别、术前吸烟史、体重指数(BMI)、术前基础疾病(慢性阻塞性肺疾病、高血压、糖尿病、贫血、低蛋白血症)、美国麻醉医师协会(ASA)评分、骨折类型(股骨颈骨折/转子间骨折)、麻醉类型(全身麻醉/椎管内麻醉)、术前等待时间≥48 h、手术时间、住院时间被列为可能的影响因素进行分析。采用单因素logistic回归分析髋关节骨折患者术后肺炎的危险因素,并将统计显著(P<0.01)的变量进行多因素logistic回归分析。结果报告为比值比(OR)和95%置信区间(95%CI)。结果:本研究中67例老年髋部骨折患者被确诊为术后肺炎,其余1137例患者未发生肺炎,肺炎发生率为5.56%。单因素logistic回归分析结果表明,年龄、吸烟史、慢性阻塞性肺疾病史、低蛋白血症、ASA评分、术前等待时间≥48 h、住院时间与老年髋部骨折患者术后肺炎有关(P<0.01)。在多因素logistic回归分析结果中,年龄(OR=1.24,95%CI:1.19~1.30,P<0.001)、吸烟史(OR=3.50,95%CI:1.89~6.50,P<0.001)、低蛋白血症(OR=2.23,95%CI:1.22~4.08,P=0.010)与老年髋部骨折患者术后肺炎独立相关。结论:年龄、吸烟史、低蛋白血症是老年髋部骨折患者发生术后肺炎的独立危险因素。

Objective:To investigate the influence factors of postoperative pneumonia in elderly hip fracture patients,and to provide reference for clinicians to prevent this complication.Methods:A retrospective analysis was performed in 1204 hip fracture patients aged 65 years old and more who underwent surgical treatment from January 2020 to March 2022.The age,gender,smoking history,body mass index(BMI),preoperative basic diseases(chronic obstructive pulmonary disease,hypertension,diabetes,anemia,and hypoalbuminaemia),American Society of Anesthesiologists(ASA)score,fracture type(femoral neck fracture or intertrochanteric fracture),anesthesia type(general anesthesia or spinal anesthesia),preoperative waiting time≥48 h,operation time and length of hospital stay were taken as posssible related factors.Univariate logistic regression analysis was used to analyze the risk factors of postoperative pneumonia in patients with hip fracture.The statistically significant variables(P<0.01)were analyzed by multivariable logistic regression.The results were reported as odd ratio(OR)and 95%confidence interval(95%CI).Results:A total of 67(5.56%)elderly patients developed pneumonia after operation,while the remaining 1137 patients did not.Univariate logistic regression analysis showed that age,smoking history,history of chronic obstructive pulmonary disease,hypoalbuminaemia,ASA score,preoperative waiting time≥48 h,and length of hospital stay were related to postoperative pneumonia(P<0.01).Moreover,multivariable analysis showed that age(OR=1.24,95%CI:1.19-1.30,P<0.001),smoking history(OR=3.5,95%CI:1.89-6.50,P<0.001)and hypoalbuminaemia(OR=2.23,95%CI:1.22-4.08,P=0.010)were identified as independent risk factors of postoperative pneumonia in elderly patients with hip fracture.Conclusions:Age,smoking history and hypoproteinemia are independent risk factors for postoperative pneumonia of hip fracture in the elderly.