ASA分级预测老年髋部骨折术后医院获得性感染的研究

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摘要目的探讨美国麻醉医师协会(American society of anesthesiologists，ASA)分级与老年髋部骨折术后医院获得性感染发生率、住院时间、住ICU时间及住院费用的关系，分析ASA分级对术后医院获得性感染的预测价值。方法回顾性分析2021年10月至2022年4月北京积水潭医院ICU收治的146例老年髋部骨折术后患者资料，根据ASA分级分为ASA Ⅱ级组和ASA Ⅲ级组，其中ASA Ⅱ级组男性32例，女性51例；中位年龄87岁；ASA Ⅲ级组男28例，女35例；中位年龄86岁。比较两组患者性别、年龄、骨折部位、麻醉方式、手术方式、术后医院获得性感染发生率、住院时间、住ICU时间及住院费用等指标，通过多因素Logistic回归分析，探讨ASA分级与术后医院获得性感染发生的关系，根据受试者工作特征(receiver operating characteristic，ROC)曲线得出ASA分级对老年髋部骨折术后医院获得性感染的预测价值。结果共纳入研究对象146例患者，其中发生术后医院获得性感染者13例，发生率为8.90%。与ASA Ⅱ级组比较，ASA Ⅲ级组患者的术后医院获得性感染发生率更高、住ICU时间更长、住院费用更多，两组比较差异有统计学意义(P＜0.05)。多因素Logistic回归分析显示，ASA分级是老年髋部骨折术后医院获得性感染发生的独立危险因素。ROC曲线显示，ASA分级可以预测老年髋部骨折术后医院获得性感染的发生，曲线下面积为0.770(P＜0.05)。结论对于老年髋部骨折术后患者，ASA Ⅲ级者术后医院获得性感染的发生率更高、住ICU时间更长、住院费用更高，ASA分级对术后医院获得性感染的发生有较好的预测价值。

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	王君
	王郝

关键词 ：老年人, 髋部骨折, 美国麻醉医师协会分级, 医院获得性感染

Abstract：Objective To investigate the correlation between the American society of anesthesiologists(ASA) classification and the occurrence rate of postoperative hospital acquired infections(HAI)，as well as the duration of hospital stay，ICU stay，and hospitalization expenses in elderly patients with hip fractures；and to assess the utility of ASA classification in predicting postoperative HAI.Methods The data of elderly postoperative hip fracture patients admitted to ICU of Beijing Jishuitan Hospital from October，2021 to April，2022 were retrospectively analyzed.According to ASA grade，the patients were divided into ASA Ⅱ group and ASA Ⅲ group.There were 32 males and 51 females in ASA Ⅱ group，with a median age of 87 years old.There were 28 males and 35 females in the ASA Ⅲ group，with a median age of 86 years old.Gender，age，fracture site，anesthesia method，operation method，incidence of postoperative HAI，length of hospital stay，ICU stay and hospitalization cost were compared between the two groups.Multivariate Logistic regression analysis was used to explore the relationship between ASA grade and postoperative HAI.According to receiver operating characteristic(ROC)curve，the value of ASA classification in predicting postoperative HAI after hip fracture in elderly patients was obtained。Results A total of 146 subjects were included in the study，of which 13 had postoperative HAI(8.90%).Compared with ASA Ⅱ group，patients in ASA Ⅲ group had higher incidence of postoperative HAI，longer stay in ICU and more hospitalization costs，and there were statistical differences between the two groups (P＜0.05).Multivariate Logistic regression analysis showed that ASA classification was an independent risk factor for postoperative HAI.ROC curve showed that ASA classification could predict the occurrence of postoperative HAI after hip fracture in elderly patients，and the area under the curve was 0.770 (P＜0.05).Conclusion For elderly patients after hip fracture surgery，the incidence of postoperative HAI is higher in those with ASA Ⅲ，the length of ICU stay is longer，and the hospitalization cost is higher.ASA grade has a good predictive value for the occurrence of postoperative HAI.

Key words： elderly hip fracture American society of anesthesiologists hospital-acquired infection

通讯作者: 王郝

作者简介: 王君(1986－ )，女，主治医师，首都医科大学附属北京积水潭医院重症医学科，xiaoyuwj@126.com

引用本文:

王君，王郝. ASA分级预测老年髋部骨折术后医院获得性感染的研究[J]. 实用骨科杂志, 2024, 30(4): 298-.
Wang Jun，Wang Hao. A Study of ASA Classification Predicting Hospital-acquired Infection After Hip Fracture Surgery in Elderly Patients. sygkzz, 2024, 30(4): 298-.

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http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2024/V30/I4/298

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