老年髋部骨折围手术期感染危险因素相关性研究

摘要

Objective To investigate the risk factors of perioperative infection in elderly patients with hip fractures. Methods A total of 221 elderly patients with hip fractures were treated in Xi'an Red Cross Hospital Affiliated to College of Medicine, Xi'an Jiaotong University and met the selection criteria. Their clinical data were collected. Infection rate and infection types were recorded, relations between infection and factors such as fracture type, surgical procedure, estimate blood loss, time in bed, psychological condition and pain degree of patient were analyzed. Results There were 17 cases of infection, with the overall infection rate of 7.7% (17/221). Pulmonary infection accounted for an absolute majority (7/17), pressure ulcer, urological infection and surgical site infection were as follows. For those who combined with chronic comorbidities, infection rate of patients with respiratory disease was the highest (12%), next, diabetes (6%). For different surgical procedures, infection rate in total hip replacement was the lowest (4%), while the rate in hollow screw fixation was the highest (13%). When the estimate bleeding amount was above 800 mL, the rate of infection increased significantly (18%). With the prolonged time in bed after the surgery, infection rate also presented increasing tendency. There were different infection rates in patients with different anxiety conditions and different pain degrees, with 14% in patients with severe anxiety and 15% in patients with severe pain. Conclusions For elderly patients with hip fracture, pulmonary infection is the main type of infection during perioperative period, followed by pressure sore. High infection rate could be seen in patients with preoperative comorbidities such as primary respiratory diseases. The related factors also include surgical procedures, estimate blood loss, time in bed, meanwhile, anxiety and pain are important risk factors for perioperative infection.%目的：探讨老年髋部骨折患者围手术期感染的危险因素。方法采集西安交通大学医学部附属红会医院收治的符合病例选择标准的221例老年髋部骨折手术患者的临床资料，记录感染发生情况及感染类型，分析骨折类型、手术方式、出血量、卧床时间、患者心理状态和疼痛程度等因素与感染的相关性。结果共发生感染17例，总感染率7.7%（17/221）。肺部感染是最主要的感染类型（7/17），其次是压疮、泌尿系感染、手术切口感染等。在合并慢性内科疾病的患者中，并发呼吸系统疾病的感染率最高（12%），其次是糖尿病（6%）。不同手术方式中全髋关节置换围手术期感染率最低（4%），空心钉内固定感染率最高（13%）；出血量在800 mL以上感染率较高（18%）；随着术后卧床时间的延长，感染率呈上升趋势。围手术期不同焦虑状态或疼痛程度的患者感染率各不相同，严重焦虑状态和严重疼痛患者感染率高达14%和15%。结论老年髋部骨折围手术期感染类型以肺部感染为主，其次为压疮；合并呼吸道原发病的患者感染率高，手术方式、出血量、卧床时间对感染率有一定影响，焦虑、疼痛是老年髋部骨折围手术期感染的重要危险因素。