髋部骨折患者住院期间新发肺部感染的危险因素分析  

Risk factors for in-hospital pulmonary infection in hip fracture patients

作　　者：尹鹏滨 吕厚辰[1] 张里程[1] 龙安华[1] 李明[1] 张立海[1] 唐佩福[1] 

机构地区：[1]解放军总医院骨科,北京100853

出　　处：《中华创伤骨科杂志》2015年第9期745-750,共6页Chinese Journal of Orthopaedic Trauma

基　　金：国家自然科学基金（81000796,3137094）

摘　　要：目的 探讨髋部骨折患者住院期间新发肺部感染的危险因素. 方法 回顾性分析2000年1月至2011年10月连续收治的50岁以上髋部骨折患者1 419例,男545例,女874例;年龄50 ～102岁.根据住院期间是否发生肺部感染分为感染组（72例,5.1％）和非感染组（1 347例,94.9％）.比较两组患者年龄、骨折类型、美国麻醉医生协会评级等手术相关因素、各个系统基础合并症、贫血、血清白蛋白、肌酐等化验指标的差异,同时采用logistic回归分析确定髋部骨折患者住院期间新发肺部感染的危险因素. 结果 女性（OR=1.764,P=0.048）、年龄（OR=1.697,P=0.002）、美国麻醉医生协会评级Ⅲ级及以上（OR=3.068,P＜0.001）、全身麻醉（OR=3.773,P=0.038）、贫血（OR =2.603,P=0.002）、低白蛋白血症（OR=1.914,P=0.019）、血清肌酐值增高（OR=3.289,P=0.014）、慢性阻塞性肺疾病（OR=2.382,P=0.049）、肿瘤（OR =2.599,P=0.042）是导致髋部骨折患者住院期间新发肺部感染风险增高的独立危险因素. 结论 针对上述危险因素采取有针对性的预防措施,如纠正低蛋白血症、改善贫血、治疗慢性阻塞性肺疾病可能在一定程度上减少肺部感染的发生,改善预后.Objective To investigate the risk factors for in-hospital pulmonary infection in senile hip fracture population.Methods A retrospective cohort study was performed in 1,419 hip fracture patients older than 50 years old who had been consecutively admitted to our department from January 2000 to October 2011.They were 545 men and 874 women,aged from 50 to 102 years.They were divided into 2 groups according to presence or absence of in-hospital pulmonary infection.There were 72 cases （5.1%） in the infection group and 1,347 cases （94.9%） in the non-infection group.The 2 groups were compared in terms of surgery related factors,like age,fracture type,American Society of Anesthesiologists （ASA） grading and anesthesia,and complications of different systems,anemia,and levels of serum proteinemia and creatinine.Candidate risk factors were evaluated by Logistic regression model to screen specific risk factors for in-hospital pulmonary infection.Results After confounding factors adjusted,woman （OR =1.764,P =0.048）,old age （OR =1.697,P =0.002）,ASA grade]Ⅲ or above （OR =3.068,P 〈 0.001）,general anesthesia （OR=3.773,P=0.038）,anemia （OR=2.603,P=0.002）,hypoproteinemia （OR=1.914,P=0.019）,high creatinine （OR =3.289,P =0.014）,chronic obstructive pulmonary disease （COPD） （OR =2.382,P =0.049）,and tumor （OR =2.599,P =0.042） were all independent risk factors for in-hospital pulmonary infection in senile hip fracture patients.Conclusion In addition to conventional treatment,senile hip fracture patients should be given other interventions,such as correction of hypoproteinemia and anemia,and specific treatment of COPD,in order to reduce the incidence of in-hospital pulmonary infection and to improve prognosis.

关 键 词：髋 骨折 危险因素 肺炎 

分 类 号：R683[医药卫生—骨科学] R563.1[医药卫生—外科学]