老年髋部骨折患者合并肺部感染特点及危险因素分析  

Analysis of clinical characteristics and risk factors for pulmonary infection in elderly patients with hip fracture

作　　者：原源[1] 田巍[1] 邓晓慧[1] 岳睿[1] 葛晓竹 吴新宝[2] 张萍[1] Yuan Yuan;Tian Wei;Deng Xiaohui;Yue Rui;Ge Xiaozhu;Wu Xinbao;Zhang Ping(Department of Geriatrics,Beijing Jishuitan Hospital,Beijing 100035,China;Department of Orthopedic Trauma,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京积水潭医院老年医学科,100035 [2]北京积水潭医院创伤骨科,100035

出　　处：《中华老年医学杂志》2019年第12期1377-1382,共6页Chinese Journal of Geriatrics

基　　金：北京市医院管理局重点医学专业发展计划(ZYLX201506)。

摘　　要：目的了解骨科与老年科共管模式治疗老年髋部骨折后,老年髋部骨折患者合并肺部感染的发生发展特点及危险因素,提出防治策略。方法收集2016年1月1日至2016年5月31日入院的老年髋部骨折治疗单元患者病例资料、化验结果等,对合并肺部感染组及无肺部感染组进行回顾性差异性比较,进一步进行了老年髋部骨折患者肺部感染的单因素及多因素分析。结果207例患者中肺部感染组43例,无肺部感染组164例。入院至手术时间<48 h比例为48.6%(86/177),入院至手术时间<1周比例为98.9%(175/177),住院天数平均(7.9±3.5)d,有无合并肺部感染两组间的入院至手术时间、手术耗时、住院天数、手术方式以及炎性指标等均无统计学差异;单因素分析结果显示,高龄、有多种基础疾病、有肺部基础疾病、慢性呼吸衰竭、脑血管病、脑血管病后遗症、免疫系统疾病或长期口服激素以及术前存在贫血均是老年髋部骨折合并肺部感染的危险因素(P<0.05或<0.01);多因素回归分析显示,高龄(OR=1.239,95%CI:1.016~1.595,P=0.051)、术前贫血(OR=2.491,95%CI:1.148~5.403,P=0.021)、存在脑血管病后遗症(OR=3.987,95%CI:1.354~11.741,P=0.012)、肺部基础疾病(OR=4.404,95%CI:1.800~11.078,P=0.001)以及免疫系统疾病(OR=17.166,95%CI:1.750~168.409,P=0.015)均为老年髋部骨折患者合并肺部感染的独立危险因素。结论骨科与老年科共管模式似乎在一定程度上控制了老年髋部骨折患者肺部感染的病情进展,缩短了术前等待时间及住院天数。但高龄、存在慢性病为老年髋部骨折患者的自身固有特点,虽为出现肺部感染的独立危险因素,却无法预防,临床应对高危人群予以重视,采取分阶段防治措施避免肺部感染的发生发展。Objective To investigate the clinical characteristics and risk factors for pulmonary infection in elderly patients with hip fracture after the treatment through a model of orthopedic-geriatric co-care,in order to provide prevention and control strategies.Methods Clinical data and laboratory results of elderly patients with hip fractures admitted into our hospital from January 2016 to May 2016 were collected.The differences in treatment outcome and adverse reactions were retrospectively compared between the two groups of patients with versus without pulmonary infection,and univariate and multivariate analysis of lung infection were performed.Results Of 207 patients,43 were infected with pneumonia and 164 were not.The proportion of patients with the time interval<48 h from admission to surgery was 48.6%(86/177),and the time interval<1 week from admission to surgery was 98.9%(175/177).The average length of hospital stay was(7.9±3.5)days.There was no significant difference in the time interval from admission to surgery,the time spent on surgery,length of hospital stay,surgical procedure and inflammatory indicators between the pneumonia and non-pneumonia groups.Univariate analysis showed that advanced age,multiple primary diseases,primary lung diseases,chronic respiratory failure,cerebrovascular disease,sequelae of cerebrovascular disease,immune system disease or long-term oral hormone therapy and preoperative anemia were risk factors for pulmonary infection in elderly patients with hip fracture(P<0.05 or<0.01).Multivariate regression analysis showed that advanced age(OR=1.239,95%CI:1.016~1.595,P=0.051),preoperative anemia(OR=2.491,95%CI:1.148~5.403,P=0.021),sequelae of cerebrovascular disease(OR=3.987,95%CI:1.354~11.741,P=0.012),primary lung diseases(OR=4.404,95%CI:1.800~11.078,P=0.001)and immune system diseases(OR=17.166,95%CI:1.750~168.409,P=0.015)were independent risk factors for pulmonary infection in elderly patients with hip fracture.Conclusions The orthopedic-geriatric co-care model seems to be in favour of c

关 键 词：髋骨折 呼吸道感染 危险因素 

分 类 号：R47[医药卫生—护理学]