目的：研究老年髋部骨折术后肺部感染危险因素以及免疫炎症因子对感染预测价值。方法：选取2020年1月―2021年12月我院髋部骨折手术患者283例为样本开展回顾性研究,整理患者病历并详细采集相关资料,然后根据术后28 d内是否发生肺部感染将患者分为感染组和对照组,比较两组各项指标并分析肺部感染危险因素,探讨免疫炎症因子对肺部感染预测价值及其与感染程度的关系。结果：283例老年髋部骨折患者术后发生肺部感染46例（16.25%）,年龄、合并症数量≥3个、骨折至入院时间、入住重症监护病房（ICU）和系统免疫炎症指数（SII）为老年髋部骨折患者术后肺部感染的独立危险因素;中性粒细胞与淋巴细胞比率（NLR）、血小板与淋巴细胞比率（PLR）和系统免疫炎症指数（systemic immune inflammation index,SII）对预测肺部感染均具有一定参考价值;NLR、PLR和SII随着肺部感染程度增加呈上升趋势,各组比较差异均有统计学意义;老年髋部骨折患者术后肺部感染患者NLR、PLR和SII与肺部感染评分均具有明显正相关性（r=0.372、0.633、0.574,P<0.05）。结论：老年髋部骨折患者术后肺部感染危险因素包括年龄、合并症数量≥3个、骨折至入院时间、入住ICU以及SII,检测NLR、PLR和SII可为判断肺部感染风险和严重程度提供参考依据。
Abstract
Objective To study the risk factors of pulmonary infection after elderly hip fracture surgery and the predictive value of immune inflammatory factors on infection. Methods 283 patients with hip fracture surgery in the hospital from January 2020 to December 2021 were selected as samples to conduct a retrospective study. The medical records of patients were sorted out and the related data were collected in detail, and the patients were divided into infection group and control group according to whether pulmonary infection occurred within 28 days after surgery. The various indicators were compared between the two groups and the risk factors of pulmonary infection were analyzed, and then the predictive value of immune inflammatory factors on pulmonary infection and relationship with infection degree were discussed. Results Among 283 elderly patients with hip fractures, 46 cases (16.25%) developed pulmonary infection after surgery. Age, number of complications≥3, time from fracture to hospital admission, intensive care unit (ICU) admission and systemic immune inflammation index (SII) were independent risk factors of postoperative pulmonary infection in elderly patients with hip fractures (P<0.05). Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and SII all had certain reference value on predicting pulmonary infection (P<0.05). NLR, PLR and SII showed increasing trends with the increase of pulmonary infection degree, and the differences between both groups were statistically significant (P<0.05). The NLR, PLR and SII were significantly positively correlated with PCIS score in elderly patients with hip fractures and postoperative pulmonary infection (r=0.372, 0.633, 0.574, P<0.05). Conclusion The risk factors of postoperative pulmonary infection in elderly patients with hip fractures include age, number of complications≥3, time from fracture to hospital admission, ICU admission and SII. The detection of NLR, PLR and SII can provide reference for determining the risk and severity of pulmonary infection.
关键词
髋部骨折 /
老年 /
外科手术 /
肺部感染 /
炎症因子 /
Logistic回归分析
Key words
hip fractures /
elderly /
surgery /
pulmonary infection /
inflammatory factors /
logistic regression analysis
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基金
首都卫生发展科研专项项目（2022-2-2073）
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