CAJ | 학술논문

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.
목적 탐토관부골절환자주원기간신발폐부감염적위험인소. 방법 회고성분석2000년1월지2011년10월련속수치적50세이상관부골절환자1 419례,남545례,녀874례;년령50 ～102세.근거주원기간시부발생폐부감염분위감염조(72례,5.1％)화비감염조(1 347례,94.9％).비교량조환자년령、골절류형、미국마취의생협회평급등수술상관인소、각개계통기출합병증、빈혈、혈청백단백、기항등화험지표적차이,동시채용logistic회귀분석학정관부골절환자주원기간신발폐부감염적위험인소. 결과 녀성(OR=1.764,P=0.048)、년령(OR=1.697,P=0.002)、미국마취의생협회평급Ⅲ급급이상(OR=3.068,P＜0.001)、전신마취(OR=3.773,P=0.038)、빈혈(OR =2.603,P=0.002)、저백단백혈증(OR=1.914,P=0.019)、혈청기항치증고(OR=3.289,P=0.014)、만성조새성폐질병(OR=2.382,P=0.049)、종류(OR =2.599,P=0.042)시도치관부골절환자주원기간신발폐부감염풍험증고적독립위험인소. 결론 침대상술위험인소채취유침대성적예방조시,여규정저단백혈증、개선빈혈、치료만성조새성폐질병가능재일정정도상감소폐부감염적발생,개선예후.
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.