老年髋部骨折患者术后医院获得性肺部感染的危险因素分析  

Risk factors for postoperative hospital-acquired pulmonary infection in elderly patients with hip fracture

作　　者：张林 翟沛 姚琦 ZHANG Lin;ZHAI Pei;YAO Qi(Beijing Century Temple Hospital Affiliated to Capital Medical University,Beijing 100038,China)

机构地区：[1]首都医科大学附属北京世纪坛医院脊柱外科,北京100038

出　　处：《中华医院感染学杂志》2020年第1期106-110,共5页Chinese Journal of Nosocomiology

基　　金：北京市科技计划基金资助项目(Z151100003915094)。

摘　　要：目的调查分析可能导致老年髋部骨折患者术后发生医院获得性肺部感染的危险因素。方法抽取首都医科大学附属北京世纪坛医院2013年1月-2018年2月收治的髋部骨折老年患者224例,回顾性分析患者一般资料,根据是否发生医院获得性肺部感染分为感染组与未感染组,分析患者痰液病原菌培养结果,单因素及多因素Logistic回归分析老年髋部骨折患者术后医院获得性肺部感染的高危因素。结果 224例老年髋部骨折患者术后发生医院获得性肺部感染20例,发生率为8.93%。20例肺部感染患者经痰液培养分离出病原菌20株,其中13株为革兰阴性菌,占65.00%,革兰阳性菌5株,占25.00%,真菌2株,占10.00%;多因素Logistic回归分析发现,高龄、骨折至入院就诊时间长、合并呼吸系统疾病、合并神经系统疾病、手术时间长、全麻、有吸烟史、有慢性阻塞性肺疾病史、贫血均可能是导致老年髋部骨折术后肺部感染的危险因素(P<0.05)。结论老年髋部骨折患者术后发生医院获得性肺部感染危险因素较多,术前积极纠正患者贫血、治疗合并症、改善肺功能,术后给予患者针对性的干预,可能会降低术后医院获得性肺部感染风险,对改善患者预后有一定临床价值。OBJECTIVE To investigate the risk factors for postoperative hospital-acquired pulmonary infection in the elderly patients with hip fracture. METHODS A total of 224 elderly patients with hip fracture who were treated in Beijing Century Temple Hospital Affiliated to Capital Medical University from Jan 2013 to Feb 2018 were enrolled in the study, the baseline data of the patients were retrospectively analyzed, the enrolled patients were divided into the infection group and the non-infection group according to the fact whether the hospital-acquired pulmonary infection was occurred, the result of sputum culture for pathogens was observed, and the univariate analysis and multivariate logistic regression analysis were performed for the high-risk factors for the postoperative hospital-acquired pulmonary infection in the elderly patients with hip fracture. RESULTS Of the 224 elderly patients with hip fracture, 20 had postoperative hospital-acquired pulmonary infection, with the incidence rate 8.93%.Totally 20 strains of pathogens were isolated from the sputum specimens that were obtained from the 20 patients with pulmonary infection, 13(65.00%) of which were gram-negative bacteria, 5(25.00%) were gram-positive bacteria and 2(10.00%) were fungi.The multivariate logistic regression analysis showed that the advanced age, long interval between fracture and admission for treatment, complication with respiratory system disease, complication with nervous system disease, long operation duration, general anesthesia, smoking history, history of chronic obstructive pulmonary disease and anemia were the risk factors for the postoperative pulmonary infection in the elderly patients with hip fracture(P<0.05). CONCLUSION There are a variety of risk factors for the postoperative hospital-acquired pulmonary infection in the elderly patients with hip fracture.It is an effective way to actively correct the anemia, treat the complications and boost the lung function before the surgery and take targeted interventions after the surgery so as t

关 键 词：髋部手术 老年患者 医院获得性肺部感染 危险因素分析 

分 类 号：R619[医药卫生—外科学]