老年股骨转子间骨折术后肺部感染相关因素分析△

Factors related to pulmonary infection after internal fixation of femoral intertrochanteric fractures in elderly

摘要:

[目的] 探讨股骨粗隆间骨折术后肺部感染的相关危险因素。[方法] 回顾性分析 2015 年 1 月—2023 年 12 月在本科接受手术治疗的 629 例老年股骨粗隆间骨折患者的临床资料。按术后 30 d 内是否发生肺部感染分为感染组 90 例和非感染组 539 例。采用单因素比较和多因素回归分析探讨相关危险因素，构建疾病预测模型及效能验证。[结果]感染组男性比率 [男/女, (44/46) vs (178/361), P=0.003]、年龄 [(86.5±7.0) 岁 vs (76.8±9.4) 岁, P＜0.001]、合并慢阻肺比率 [是/否, (47/43) vs (11/528), P＜0.001]、 冠心病比率 [是/否, (19/71) vs (50/489), P=0.002]、吸烟比率 [是/否, (49/41) vs (184/355), P＜0.001]、认知障碍比率 [是/否, (48/42) vs (81/ 458), P＜0.001]、NLR [(8.0±4.6) vs (5.3±2.0), P＜0.001]、全麻比率 [椎管/全麻, (44/46) vs (388/151), P＜0.001]、术中吸痰的比率、采用 LISS 钢板比率、切口长度、术中失血量、总中失血量均显著高于未感染组 （P＜0.05）。多元逻辑回归分析显示慢阻肺 （OR= 151.48, P＜0.001）、全麻 （OR=9.85, P＜0.001）、认知障碍 （OR=3.16, P=0.027）、术前高 NLR （OR=1.75, P＜0.001）、年龄 （OR= 1.28, P＜0.001） 是骨折术后肺部感染的独立危险因素。ROC 曲线显示，预测模型 ROC 曲线下面积为 AUC=0.96 （95% CI 0.96~ 0.98, P＜0.001）。[结论]年龄、慢阻肺、认知障碍、术前 NLR、麻醉类型是股骨粗隆间骨折术后肺部感染的独立危险因素，建立的疾病预测列线图可以有效判别术后肺部感染的发生风险。

Abstract:

[Objective] To search the factors related to pulmonary infection after internal fixation of femoral intertrochanteric fractures in the elderly. [Methods] A retrospective study was conducted on 629 elderly who had femoral intertrochanteric fractures fixed surgically in our department from January 2015 to December 2023. According to the occurrence of pulmonary infection within 30 days after surgery, 90 patients were fall into the infection group, while the remaining 539 patients were classified as the non-infected group. Univariate comparison and multiple logic regression were used to search the related risk factors, additionally, a disease prediction model was constructed and its efficacy was verified. [Results] As results of univariate comparison, the infection group proved significantly greater than the non-infection group in terms of male ratio [male/female, (44/46) vs (178/361), P=0.003], age [(86.5±7.0) years vs (76.8±9.4) years, P<0.001], chronic obstructive pulmonary disease (COPD) ratio [y/n, (47/43) vs (11/528), P<0.001], coronary heart disease (CHD) ratios [y/n, (19/71) vs (50/489), P=0.002], smoking ration [y/n, (49/41) vs (184/355), P<0.001], cognitive impairment ratio [y/n, (48/42) vs (81/458), P<0.001], NLR [(8.0±4.6) vs (5.3± 2.0), P<0.001], the general anesthesia ratio [intravertebral anesthesia / general anesthesia (44/46) vs (388/151), P<0.001], the ratio of intraoperative sputum aspiration (P<0.05), the ratio of LISS plate used (P<0.05), incision length (P<0.05), intraoperative blood loss and total blood loss (P<0.05). As for multiple logistic regression analysis, the COPD (OR=151.48, P<0.001), general anesthesia (OR=9.85, P<0.001), cognitive impairment (OR=3.16, P=0.027), preoperative high NLR (OR=1.75, P<0.001), advanced age (OR=1.28, P<0.001) were the independent risk factor for pulmonary infection. The ROC curve showed that the area under curve (AUC) of the predictive model was of 0.96 (95%CI 0.96~ 0.98,P<0.001). [Conclusion] The advanced age, COPD, cognitive impairment, preoperative high NLR and general anesthesia are independent risk factors for pulmonary infection after internal fixation of the femoral intertrochanteric fractures. This established disease prediction nomogram might effectively distinguish the occurrence of postoperative pulmonary infection risk.