骨科老年患者术后肺部感染的监测与分析
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摘要
目的了解骨科老年患者术后肺部感染的发生情况与感染特点,为预防与控制骨科医院感染提供参考。方法监测重庆市某三级甲等综合医院2014年1月1日-2017年12月31日骨科老年患者术后肺部感染的发生情况,分析其肺部感染发生率与流行特点。结果监测骨科老年手术患者2251例,发生术后肺部感染61例,术后肺部感染发生率为2.71%;男性肺部感染发生率(3.68%)高于女性(2.04%),差异具有统计学意义(P<0.05);各年龄组肺部感染发生率由低到高依次为60-69岁组(2.00%)、70-79岁组(2.62%)、≥80岁组(4.68%),差异具有统计学意义(P<0.05);脊柱组、创伤组、关节组肺部感染发生率差异无统计学意义(P>0.05)。共检出病原菌113株,其中多重耐药菌20株(17.70%),前3位病原菌依次为肺炎克雷伯菌(27.43%)、鲍曼不动杆菌(14.16%)、白假丝酵母菌(11.50%)。术后肺部感染患者病死率(4.92%)显著高于非肺部感染患者(2.05%),差异有统计学意义(P<0.05)。结论骨科老年患者术后肺部感染男性高于女性,以革兰氏阴性菌为主,细菌耐药性较高,应针对其特点积极采取预防措施,降低术后肺部感染发生率与病死率。
Objective To investigate the incidence and characteristics of postoperative pulmonary infection(PPI) in elderly patients with orthopaedics, and to provides reference for the prevention and treatment of nosocomial infection in orthopedics department.Methods The incidence of PPI in elderly patients with orthopaedics was monitored from January 1, 2014 to December 31, 2017 in a third-grade general hospital of chongqing, and the incidence and prevalence characteristics of PPI were analyzed.Results 2251 elderly patients with orthopaedic surgery were monitored,and 61 cases of PPI occurred. The incidence of PPI was 2.71%.The incidence of PPI in males(3.68%) was higher than that in females(2.04%), and the difference was statistically significant(P<0.05).The incidence of PPI in each age group was from low to high, which was followed by the group aged 60-69 years(2.00%), the group aged 70-79 years(2.62%), and the group aged more than 80 years(4.68%). The difference was statistically significant(P<0.05).There was no statistically significant difference in the incidence of PPI between the spine group, the trauma group and the joint group(P>0.05).A total of 113 strains of pathogenic bacteria were detected, including 20 strains(17.70%) of multi-drug resistant bacteria, and the top 3 pathogens were respectively klebsiella pneumoniae(27.43%),acinetobacter baumannii(14.16%) and candida albicans(11.50%).The mortality rate of patients with PPI(4.92%) was significantly higher than that of patients with non-pulmonary infection(2.05%),and the difference was statistically significant(P<0.05). Conclusion The incidence of PPI in elderly patients with orthopaedics is high, and preventive measures should be taken to reduce the incidence and mortality of PPI according to their characteristics.
Objective To investigate the incidence and characteristics of postoperative pulmonary infection(PPI) in elderly patients with orthopaedics, and to provides reference for the prevention and treatment of nosocomial infection in orthopedics department.Methods The incidence of PPI in elderly patients with orthopaedics was monitored from January 1, 2014 to December 31, 2017 in a third-grade general hospital of chongqing, and the incidence and prevalence characteristics of PPI were analyzed.Results 2251 elderly patients with orthopaedic surgery were monitored,and 61 cases of PPI occurred. The incidence of PPI was 2.71%.The incidence of PPI in males(3.68%) was higher than that in females(2.04%), and the difference was statistically significant(P<0.05).The incidence of PPI in each age group was from low to high, which was followed by the group aged 60-69 years(2.00%), the group aged 70-79 years(2.62%), and the group aged more than 80 years(4.68%). The difference was statistically significant(P<0.05).There was no statistically significant difference in the incidence of PPI between the spine group, the trauma group and the joint group(P>0.05).A total of 113 strains of pathogenic bacteria were detected, including 20 strains(17.70%) of multi-drug resistant bacteria, and the top 3 pathogens were respectively klebsiella pneumoniae(27.43%),acinetobacter baumannii(14.16%) and candida albicans(11.50%).The mortality rate of patients with PPI(4.92%) was significantly higher than that of patients with non-pulmonary infection(2.05%),and the difference was statistically significant(P<0.05). Conclusion The incidence of PPI in elderly patients with orthopaedics is high, and preventive measures should be taken to reduce the incidence and mortality of PPI according to their characteristics.
引文
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[9]曹聪,刘海春,武文亮,等.高龄髋部骨折后死亡原因调查及相关因素分析[J].医学与哲学,2015,36(3B):48-50.
[10]Nikkel LE,Kates SL,Schreck M,et al.Length of hospital stay after hip fracture and risk of early mortality after discharge in New York state:retrospective cohort study[J].BMJ,2015,351:h6246.
[11]曹桂花,葛伟,薛明涛.高龄肺部感染患者多重耐药菌的分布及临床特点[J].中华老年多器官疾病杂志,2018,17(10):753-756.
[2]WS 382-2012,医院获得性肺炎诊断标准[S].
[3]Lv H,Yin P,Long A,et al.Clinical characteristics and risk factors of postoperative pneumonia after hip fracture surgery:a prospective cohort study[J].Osteoporosis International,2016,27(10):1-9.
[4]沈彩芳,占利.ICU患者肺部感染危险因素分析[J].中华医院感染学杂志,2014,24(7):1673-1674.
[5]Leino K,Kuusniemi K,Lertola KK,et al.Comparison of four pain scales in patients with hip fracture or other lower limb trauma[J].Acta Anaesthesiologica Scandinavica,2011,55(4):495-502.
[6]王凡,韩志海,孟激光,等.血液病合并侵袭性真菌感染病原学及危险因素[J].中国感染控制杂志,2015,14(10):672-675.
[7]杜斌.围手术期肺部感染预防及处理[J].中国实用外科杂志,2016,36(2):171-174.
[8]庄建文,朱熠,潘颖颖,等.外科手术部位感染危险因素分析及对策[J].中国消毒学杂志,2018,35(09):675-676.
[9]曹聪,刘海春,武文亮,等.高龄髋部骨折后死亡原因调查及相关因素分析[J].医学与哲学,2015,36(3B):48-50.
[10]Nikkel LE,Kates SL,Schreck M,et al.Length of hospital stay after hip fracture and risk of early mortality after discharge in New York state:retrospective cohort study[J].BMJ,2015,351:h6246.
[11]曹桂花,葛伟,薛明涛.高龄肺部感染患者多重耐药菌的分布及临床特点[J].中华老年多器官疾病杂志,2018,17(10):753-756.