高龄患者髋部骨折术中获得性压力性损伤的影响因素

Influencing factors for intraoperative acquired pressure injury in elderly patients with hip fractures

目的探讨高龄患者髋部骨折术中获得性压力性损伤(IAPI)的分布情况及影响因素。方法选取2022年1月至2023年6月于江苏省第二中医院手术室行髋部骨折手术的238例高龄患者为研究对象。根据是否发生IAPA,将患者分为IAPA组(n=41)和对照组(n=197)。采用SPSS 22.0统计软件进行数据分析。根据数据类型,组间比较分别采用独立样本t检验或χ2检验。采用logistic回归模型分析高龄髋部骨折手术患者发生IAPA的影响因素。结果238例患者中发生IAPI者41例,发生率为17.23%。其中,常见的损伤部位为骶尾部(21例,51.22%)、脚跟(9例,21.95%)以及脚底(5例,12.20%),IAPI分期1期者19例(46.34%)、2期者13例(31.71%)、3期者5例(12.20%)、4期者4例(9.76%)。二元logistic回归分析显示年龄(OR=1.143,95%CI 1.045~1.251)、体质量指数(BMI)≤18.5 kg/m^(2)或>28 kg/m^(2)(OR=1.652,95%CI 1.038~2.629)、糖尿病(OR=2.073,95%CI 1.186~3.624)、骨折至手术时间(OR=1.201,95%CI 1.039~1.388)以及每日翻身次数(OR=0.388,95%CI 0.209~0.721)为高龄髋部骨折手术患者发生IAPI的独立影响因素(P<0.05)。结论高龄髋部骨折手术患者IAPI发生率较高,且损伤通常分布于骶尾部、脚跟和脚底等部位,年龄、BMI、糖尿病、骨折至手术时间以及每日翻身次数为IAPI的影响因素。

Objective To explore the distribution and influencing factors of intraoperative acquired pressure injury(IAPI)in elderly patients with hip fractures.Methods A total of 238 elderly patients undergoing hip fracture surgery in our hospital from January 2022 to June 2023 were recruited,and according to IAPA occurrence or not,they were divided into IAPA group(n=41)and control group(n=197).SPSS 22.0 was used for data analysis.Depending on data type,independent sample t test or Chi-square test was applied for intergroup comparison.Logistic regression model was established to analyze the influencing factors for the occurrence of IAPA in the elderly patients with hip fractures.Results Among the 238 patients,41 cases developed IAPI,with an incidence rate of 17.23%.The common sites were sacrococcygeal region(21 cases,51.22%),heel(9 cases,21.95%)and sole(5 cases,12.20%).There were 19 patients(46.34%)of IAPI stage 1,13 patients(31.71%)of stage 2,5 patients(12.20%)of stage 3 and 4 patients(9.76%)of stage 4.Binary logistic regression analysis showed that age(OR=1.143,95%CI 1.045-1.251),body mass index(BMI)≤18.5 kg/m^(2) or>28 kg/m^(2)(OR=1.652,95%CI 1.038-2.629),diabetes mellitus(OR=2.073,95%CI 1.186-3.624),time from fracture to surgery(OR=1.201,95%CI 1.039-1.388)and frequency of turning over≥3 times per day(OR=0.388,95%CI 0.209-0.721)were independent influencing factors for IAPI in elderly patients undergoing hip fracture surgery(P<0.05).Conclusion The incidence of IAPI is quite high in elderly patients undergoing hip fracture surgery,and the injuries are common in sacrococcygeal region,heel and sole.Age,BMI,diabetes mellitus,time from fracture to surgery and frequency of turning over per day are the influencing factors for IAPI occurrence.