老年髋部骨折术后肺部感染病原菌与影响因素

Distribution of pathogenic bacteria of pulmonary infection and its risk factors in elderly patients after hip fracture surgery

目的探究老年髋部骨折术后肺部感染病原菌分布情况及其影响因素。方法回顾性选取2018年1月-2020年9月于临安区第一人民医院行髋部骨折手术的335例老年患者为研究对象,全部患者于术后随访30 d,无失访病例,患者按术后是否发生肺部感染分为肺部感染组(30例)和非肺部感染组(305例);分析肺部感染组患者病原菌分布情况,通过单因素及多因素分析法分析老年髋部骨折术后肺部感染的危险因素。结果老年髋部骨折术后肺部感染的发生率为8.96%,肺部感染组分离出病原菌30株,其中革兰阴性菌18株(60.00%),革兰阳性菌8株(26.67%),真菌4株(13.33%);年龄>70岁、有慢性阻塞性肺疾病史、超敏C-反应蛋白(hs-CRP)水平高为老年髋部骨折术后肺部感染的危险因素(P<0.05)。结论老年髋部骨折术后肺部感染发生率较高,病原菌多以革兰阴性菌居多,其发生与患者年龄、慢性阻塞性肺疾病史、hs-CRP水平密切相关,临床需针对性地做好相应预防措施,以降低老年髋部骨折术后肺部感染的发生风险。

OBJECTIVE To explore the distribution of pathogens and influencing factors for pulmonary infection in the elderly patients after hip fracture surgery.METHODS Clinical data of 335 elderly patients underwent hip fracture surgery in the First People′s Hospital of Lin′an from Jan 2020 to Apr 2022 were retrospectively collected.All patients were followed up for 30 days after surgery,and no case was lost.According to whether postoperative pulmonary infection occurred,the patients were divided into the pulmonary infection group(30 cases)and the non-pulmonary infection group(305 cases).The distribution of pathogens in the pulmonary infection group was analyzed,and the risk factors for pulmonary infection after hip fracture surgery in the elderly patients were analyzed by univariate and multivariate analysis.RESULTS The incidence of pulmonary infection after hip fracture surgery in the elderly patients was 8.96%.In the pulmonary infection group,30 strains of pathogenic bacteria were isolated,including 18 strains of gram-negative bacteria(60.00%),8 strains of gram-positive bacteria(26.67%)and 4 strains of fungi(13.33%).Age>70 years old,history of chronic obstructive pulmonary disease,high level of high-sensitivity C-reactive protein(hs-CRP)were risk factors for pulmonary infection after hip fracture surgery in the elderly patients(P<0.05).CONCLUSION The incidence of pulmonary infection after hip fracture surgery is high in elderly patients,and the pathogenic bacteria are mainly gram-negative bacteria,which are closely related to the age of patients,history of chronic obstructive pulmonary disease,and hs-CRP level.Clinical prevention measures should be targeted to reduce the risk of pulmonary infection after hip fracture in elderly patients.