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研究

Influencing Factors Research of Perioperative Nosocomial Infections of Elderly Patients with Hip Fractures Under Background of Accelerated Rehabilitation

目的分析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。方法对本院2020年1月—2022年12月开展加速康复管理后收治的200例进行手术治疗的老年髋部骨折患者临床资料进行回顾性分析,统计其手术治疗后围手术期医院感染发生情况,根据其是否发生围手术期医院感染进行分组,并且采集其临床资料,对影响其发生围手术期医院感染的相关因素进行单因素分析和多因素Logistic分析。结果200例患者中共计16例(8.00%)发生围手术期医院感染,16例患者中,下呼吸道感染患者、泌尿道感染患者、手术部位感染患者分别8例(50.00%)、5例(31.25%)和3例(18.75%)。发生围手术期医院感染患者在年龄、住院时间、合并慢性病、下肢动脉硬化闭塞症、心功能不全、留置尿管、骨牵引及老年痴呆方面和未发生围手术期医院感染患者存在明显差异(P<0.05)。多因素Logistic回归分析结果显示,合并下肢动脉硬化闭塞症、心功能不全、留置尿管、骨牵引及老年痴呆是影响患者发生围手术期医院感染的独立危险因素(P<0.05)。结论在加速康复背景下,老年髋部骨折患者手术治疗期间具有一定的围手术期医院感染风险,其中合并下肢动脉硬化闭塞症、心功能不全、留置尿管、骨牵引及老年痴呆是影响其发生围手术期医院感染的独立危险因素,临床需要在加速康复外科理念下对患者围术期管理措施作进一步优化,以在更大程度上提高患者围手术期医院感染的预防效果。

Objective To analyze influencing factors of perioperative nosocomial infections of elderly patients with hip fractures under background of accelerated rehabilitation.Methods The paper reviewed and analyzed clinical data of 200 elderly patients with hip fractures with surgical treatment and accelerated rehabilitation management in our hospital from January 2020 to December 2022,and analyzed incidence of perioperative nosocomial infections after surgical treatment statistically,divided them into groups according to condition of perioperative nosocomial infections,and collected clinical data.Univariate analysis and multivariate logistic analysis was carried out based on factors affecting incidence of perioperative nosocomial infections.Results There were 16 cases with perioperative nosocomial infections out of 200(8.00%),including 8(50.00%)cases of lower respirat ory tract infections,5(31.25%)cases of urinary tract infections,and 3(18.75%)cases of surgical site infections respectively.There was significant difference in age,length of stay,comorbidities with chronic diseases,lower limb arteriosclerosis obliterans,heart failure,indwelling catheters,bone traction and elderly dementia between patients with and without perioperative nosocomial infections,(P<0.05).Multivariate logistic regression analysis showed,comorbidities of lower limb arteriosclerosis obliterans,cardiac dysfunction,indwelling catheters,bone traction,and senile dementia were independent risk factors for perioperative nosocomial infections of patients(P<0.05).Conclusion Under background of accelerated rehabilitation,elderly patients with hip fractures have some certain risk of perioperative nosocomial infections during surgical treatment.Independent risk factors affecting incidence of perioperative nosocomial infections include combination of lower limb arteriosclerosis obliterans,heart failure,indwelling catheters,skeletal traction and senile dementia.It is necessary to further optimize perioperative management measures for patients under concept of accelerated rehabilitation surgery to improve prevention effect of perioperative nosocomial infections to a greater extent.