老年髋部骨折患者术后并发肺部感染的相关影响因素及干预对策

目的 探讨老年髋部骨折患者接受相关手术治疗后并发肺部感染的危险因素,并基于此给予相应的干预对策,为改善患者预后提供参考依据。方法 回顾性分析北京市房山区良乡医院2020年1月至2022年6月收治的210例老年髋部骨折患者的临床资料,依据患者术后肺部感染情况分为无肺部感染组(165例)和肺部感染组(45例)。对两组老年髋部骨折患者的临床资料进行单因素分析和多因素Logistic回归分析,筛选出影响老年髋部骨折患者术后并发肺部感染的危险因素。结果 单因素分析结果表明,相比于无肺部感染组,肺部感染组患者年龄显著升高,手术时间显著延长;肺部感染组存在吸烟史、合并慢性阻塞性肺疾病、糖尿病、低蛋白血症、贫血的患者占比均显著高于无肺部感染组;影响老年髋部骨折患者术后并发肺部感染的危险因素为年龄较大、存在吸烟史、合并慢性阻塞性肺疾病、糖尿病、低蛋白血症、贫血、手术时间较长(OR=1.818、1.881、2.046、2.275、1.970、2.098、1.939,均P<0.05)。结论 对于老年髋部骨折患者,年龄较大、存在吸烟史、合并慢性阻塞性肺疾病、糖尿病、低蛋白血症、贫血、手术时间较长均为影响...     

北京市髋部骨折发生率流行病学研究

为了解北京市髋部骨折发生率，调查了北京市所有能收治骨折的７６所医院１９８８￣１９９２年髋部骨折的出院病例。为避免遗漏非住院治疗的髋部骨折，在北京城区随机抽样２１１３名５０岁以上妇女进行入户调查以了解过去骨折史。应答率９７％。所有资料经多方面、系统的有效性核实。基于１９９０年人口普查资料，计算出北京市年龄标化后的髋部骨折发生率女性为８８／１０万，男性为９７／１０万。用同样方法和人群标化的其它国家和地     

老年髋部骨折术后肺部感染病原菌与影响因素

目的 探究老年髋部骨折术后肺部感染病原菌分布情况及其影响因素。方法 回顾性选取2018年1月-2020年9月于临安区第一人民医院行髋部骨折手术的335例老年患者为研究对象，全部患者于术后随访30 d,无失访病例，患者按术后是否发生肺部感染分为肺部感染组(30例)和非肺部感染组(305例);分析肺部感染组患者病原菌分布情况，通过单因素及多因素分析法分析老年髋部骨折术后肺部感染的危险因素。结果 老年髋部骨折术后肺部感染的发生率为8.96%,肺部感染组分离出病原菌30株，其中革兰阴性菌18株(60.00%),革兰阳性菌8株(26.67%),真菌4株(13.33%);年龄>70岁、有慢性阻塞性肺疾病史、超敏C-反应蛋白(hs-CRP)水平高为老年髋部骨折术后肺部感染的危险因素(P<0.05)。结论 老年髋部骨折术后肺部感染发生率较高，病原菌多以革兰阴性菌居多，其发生与患者年龄、慢性阻塞性肺疾病史、hs-CRP水平密切相关，临床需针对性地做好相应预防措施，以降低老年髋部骨折术后肺部感染的发生风险。     

老年髋部骨折患者术后医院获得性肺部感染的危险因素分析

目的调查分析可能导致老年髋部骨折患者术后发生医院获得性肺部感染的危险因素。方法抽取首都医科大学附属北京世纪坛医院2013年1月-2018年2月收治的髋部骨折老年患者224例,回顾性分析患者一般资料,根据是否发生医院获得性肺部感染分为感染组与未感染组,分析患者痰液病原菌培养结果,单因素及多因素Logistic回归分析老年髋部骨折患者术后医院获得性肺部感染的高危因素。结果 224例老年髋部骨折患者术后发生医院获得性肺部感染20例,发生率为8.93%。20例肺部感染患者经痰液培养分离出病原菌20株,其中13株为革兰阴性菌,占65.00%,革兰阳性菌5株,占25.00%,真菌2株,占10.00%;多因素Logistic回归分析发现,高龄、骨折至入院就诊时间长、合并呼吸系统疾病、合并神经系统疾病、手术时间长、全麻、有吸烟史、有慢性阻塞性肺疾病史、贫血均可能是导致老年髋部骨折术后肺部感染的危险因素(P<0.05)。结论老年髋部骨折患者术后发生医院获得性肺部感染危险因素较多,术前积极纠正患者贫血、治疗合并症、改善肺功能,术后给予患者针对性的干预,可能会降低术后医院获得性肺部感染风险,对改善患者预后有一定临床价值。     

老年骨质疏松性骨折的影响因素及社区康复效果

目的探讨老年骨质疏松性骨折的影响因素及社区康复治疗对患者的治疗效果。方法选取2015年1月—2017年1月同济大学附属杨浦医院收治的老年骨质疏松症患者300例,根据患者是否出现骨折分为对照组(n=150,非骨折组)和观察组(n=150,骨折组),对比分析老年骨质疏松性骨折的影响因素,同时给予社区康复治疗,探讨社区康复治疗效果。结果经骨折的影响因素分析结果显示,年龄、TC、LDL、总髋部BMD水平及阳光照射情况均为老年骨质疏松患者骨折发生的影响因素(P0.05);经logistic回归分析显示,女性、年龄较大、缺乏阳光照射和总髋部BMD水平低均为老年骨质疏松患者发生骨折的独立危险因素(P0.05);老年骨质疏松性骨折患者经社区康复治疗其前屈后伸痛、翻身痛、负重痛及总髋部BMD水平均有所改善(P0.05)。结论女性、年龄较大、缺乏阳光照射及总髋部BMD水平低均为老年骨质疏松患者发生骨折的独立危险因素,临床医生应根据患者的实际情况有针对性地实施社区康复。     

健康教育在老年骨质疏松性髋部骨折护理中的应用

目的探讨老年骨质疏松性髋部骨折的危险因素,并提出相应的健康教育,以提高其生活质量。方法对92例老年骨质疏松性髋部骨折患者进行问卷调查,分析骨折的诱发因素、以往含钙相关饮食、运动锻炼等情况,并提出健康教育。结果老年人对骨质疏松症相关知识及预防方法缺乏认识,营养摄入减少是主要诱因,跌倒是导致其髋部骨折的主要危险因素。结论骨质疏松性老年患者受轻微外力作用即可发生骨折,护理人员应针对其危险因素,采取有效的健康教育干预措施,降低老年骨质疏松性髋部骨折发生率。     

476例老年人髋部骨折构成分析

目的：通过对两家医院476例50岁以上老年人髋部骨折构成及其危险因素的调查并进行分析,可以反映导致老年人髋部骨折主要因素,为预防骨折发生提供依据。方法回顾性分析476例老年髋部骨折住院病人的性别、年龄、骨折类型、损伤外因以及基础病等特点。结果2008-2012年50岁以上人口发生髋部骨折476例,男性188例,女性288例,女性多于男性。结论老年人应重视和预防骨质疏松,减少跌倒和意外伤害的发生,加强老年病的防治,预防髋部骨折的发生。     

北京市房山区老年性白内障危险因素病例对照研究

通过病例对照研究探讨老年性白内障的危险因素，为病因学研究提供线索。１１３例病例选自１９９０年北京市房山区眼病普查中确诊的３８６例老年性白内障病人，并采用１∶１配对的方法从该地区随机抽取１１３名对照。研究结果表明高血压病史、开始眼花年龄、一级亲属家族史是老年性白内障的主要危险因素。结果提示老年性白内障是由环境因素和遗传因素共同作用而发生的老年性疾病。     

高龄患者髋部骨折术后意识障碍原因分析及干预

目的:分析高龄患者髋部骨折术后意识障碍原因,探讨干预措施。方法:选择2015-05~2017-05于我院行髋部骨折手术的120例高龄患者作为研究对象。观察本组术后意识障碍的发生情况,并将其分为意识障碍组与无意识障碍组。详细记录意识障碍组与无意识障碍组患者年龄、性别、BMI、术前白蛋白、术前血红蛋白、基础疾病、麻醉方式、手术方式、手术时间、低氧血症发生情况,采用单因素分析筛选可能导致术后意识障碍的危险因素,以Logistic回归分析,筛选出高龄患者髋部骨折术后意识障碍的独立危险因素。结果:本组120例患者中,发生术后意识障碍35例(29.17%),经单因素分析与Logistic回归分析显示,年龄≥80岁、术前白蛋白35g/L、合并基础疾病、全麻、存在低氧血症是高龄患者髋部骨折术后意识障碍的独立危险因素(P0.05)。结论:高龄患者髋部骨折术后意识障碍原因主要与年龄、术前白蛋白水症、基础疾病、全麻、低氧血症有关,临床工作中应给予足够的重视。     

合肥市省级医院髋部骨折流行病学分析

目的　了解合肥市省级医院髋部骨折病例的流行病学状况。方法　入医院病案室调集1998～ 2 0 0 2年全部髋部骨折病例 ,设计调查表进行相关因素的登记 ,对髋部骨折的流行特征及 5年发生情况进行动态分析。结果　合肥市省级医院 1998～ 2 0 0 2年共收治髋部骨折病例 10 5 8例 ,其中股骨颈骨折 6 6 7例 ,股骨粗隆间骨折 391例 ,女性略多于男性 ,左侧多于右侧 (左侧与右侧之比股骨颈骨折为 1.2 0∶ 1,粗隆间骨折为 1.0 8∶ 1) ,从事体力劳动者多见 ,骨折的原因分析中跌倒扭伤占 73.4 4 % ;趋势分析发现髋部骨折发生率随年龄增长而增大 ,6 0～ 80 a为发生高峰年龄 ;时间上来看合肥市省级医院髋部骨折近 5年发生率呈总体上升趋势 (P <0 .0 5 ) ;性别上看男性髋部骨折发生率近 5年呈上升趋势 (P <0 .0 5 ) ,年均上升 9.6 8% ;女性似有下降趋势 ,年均下降0 .75 % ,但无显著性差异 (P >0 .0 5 )。髋部骨折发生季节分析结果表明冬季为高发季节。结论　合肥市省级医院髋部骨折病例近 5年呈上升趋势 ,预防的重点人群为中老年人     

Tobacco smoking and risk of hip fracture in men and women

BACKGROUND: Previous findings suggest that tobacco smoking increases the risk of hip fracture in women. A similar adverse effect of smoking is suspected to be present in men, but bone mineral density studies have raised the concern that men may be more sensitive to the deleterious effect of smoking on bone than women. In this study we prospectively determined the influence of current, previous, and cumulative smoking history on risk of hip fracture in men and women and addressed the issue of possible gender difference in the susceptibility to tobacco smoking. METHODS: Pooled data from three population studies conducted in Copenhagen with detailed information on smoking habit. A total of 13,393 women and 17,379 men, initially examined between 1964 and 1992, were followed until 1997 for first admission due to hip fracture. The relative risks (RR) of hip fracture associated with smoking were estimated by means of multiplicative Poisson regression models. RESULTS: During follow-up, 722 hip fractures were identified in women, and 447 in men. After adjustment for potential confounders, including body mass index, female current smokers had an RR of hip fracture of 1.36 (95% CI: 1.12-1.65) and male smokers 1.59 (95% CI: 1.04-2.43) relative to never smokers. In both sexes, the RR of hip fracture gradually increased by current and accumulated tobacco consumption. The RR were consistently higher in men than in women, but the test for interaction between sex and tobacco smoking was insignificant. After 5 years, male ex-smokers had an adjusted RR of 0.73 (95% CI: 0.55-0.98) relative to current smokers, while no significant decrease in risk was observed in female ex-smokers (RR = 0.91; 95% CI: 0.72-1.17)). Approximately 19% of all hip fractures in the present study population were attributable to tobacco smoking. CONCLUSION: Tobacco smoking is an independent risk factor for hip fracture in men and women, and there appears to be no gender differences in smoking related risk. Smoking cessation reduces the risk of hip fracture in men after 5 years, while the deleterious effect of smoking seems to be more long-lasting in female ex-smokers.     

Physical inactivity is an independent risk factor for hip fracture in the elderly.

STUDY OBJECTIVE--To test the hypothesis that physical inactivity is an independent risk factor for hip fracture in the elderly. DESIGN--Population based, case-control study. SETTING--Metropolitan borough of Newcastle upon Tyne. PARTICIPANT--A total of 197 patients aged 50 years and over, resident in Newcastle, and admitted consecutively with a hip fracture, and 382 community controls, matched by age and sex, who had not suffered a hip fracture. MEASUREMENTS AND MAIN RESULTS--Validated methods were used to assess customary physical activity. Information on body build, cigarette smoking, and alcohol consumption was also obtained. Grip strength was measured. Physical inactivity was strongly associated with the risk of hip fracture in men and women. Subjects who did not regularly weight-bear, perform muscle-loading activities such as climbing stairs, and perform productive activities such as gardening, were all more than twice as likely to sustain a hip fracture, when compared with subjects at the higher end of the activity spectrum. These increases in risk remained after adjusting for body mass index, smoking, alcohol consumption, and dependence in daily living activities. CONCLUSIONS--Customary physical inactivity is an independent determinant of hip fracture in the elderly. Strategies to improve the day to day activity of elderly people require urgent exploration.     

Who is at risk of osteoporosis?

This contribution assesses who is at risk of osteoporosis, by delineating the key risk factors involved in the condition. Osteoporosis represents a major public health problem through its association with fragility fractures, primarily of the hip, spine and distal forearm. Some risk factors for fragility fracture act through bone mineral density (BMD), for example female gender, asian or Caucasian race, premature menopause, primary or secondary amenorrhoea, primary and secondary hypogonadism in men, prolongued immobilisation, low dietary calcium intake, vitamin D deficiency. However, a number of others contribute significantly to fracture risk over and above their association with BMD (age, high bone turnover, poor visual acuity, neuromuscular disorders, previous fragility fracture, glucocorticoid therapy, family history of hip fracture, low body weight, cigarette smoking, excess alcohol consumption).     

上海市两区618例老年人骨密度及相关因素

[目的]研究影响上海市两区(地处中心城区)老年人骨密度的相关因素。[方法]采用经培训专职人员一对一方式对户籍为上海市两区的618名60岁及以上老年人进行问卷调查,应用骨密度仪对受试者足踝部进行骨密度(BMD)测定。对测得结果进行多元逐步回归分析。[结果]老年人年龄、性别、饮碳酸饮料、户外运动、服用钙片、既往骨折史与骨密度高低具有相关性(P0.05)。老年女性经常饮用碳酸饮料,骨密度下降明显(P0.05);老年男性经常饮酒,骨密度下降明显(P0.05)。[结论]该两区老年人具有较明显的地域生活习性,在注重年龄、性别、既往有骨折史等骨质疏松危险因素预防的同时,应鼓励老年人多进行户外运动、定期服用钙片等。老年女性应避免或少饮用碳酸饮料,老年男性应不饮酒或少饮酒。     

Race and sex differences in hip fracture incidence

Incidence rates for hip fracture in the United States were estimated using non-federal hospital discharges from the National Hospital Discharge Survey for the years 1974-1979. Age-specific incidence curves for women and for men showed similar patterns of increase in risk with age, with risks approximately doubling every five years after age 50. Age-specific rates by five-year age groups were compared among the four race-sex groups. No significant differences were observed between Black females, Black males, and White males. In contrast, rates for White females were one and one-half to four times those for Black females after age 40 and were approximately double those for White males after age 50. Analysis based on an independent data source of non-federal hospital discharges in Washington, DC confirmed these relationships. In the Washington study, White women were at twice the risk for hip fracture (controlled for age) compared with Black women and at 2.7 times the risk for hip fracture (controlled for age) compared to White men. No significant differences were observed between Black women and Black men.     

Estimation of absolute fracture risk among middle-aged and older men and women: the EPIC-Norfolk population cohort study

While estimates of relative risks associated with risk factors such as age and bone mineral density (BMD) may be of interest for etiologic and comparative purposes, clinical questions such as who might benefit most from preventive interventions or BMD monitoring depend on estimates of absolute fracture risk. The European prospective investigation into cancer (EPIC)-Norfolk study included 25,311 participants (11,476 men) aged 4,079 years in 1993–1997. All participants were followed for osteoporotic fractures to March 2007. Ten-year absolute risk of fracture in men and women were calculated using the baseline survivor function in multivariable Cox proportional-hazards models adjusting for age, sex, history of fractures, body mass index, smoking, and alcohol intake. In comparison of those without history of fracture versus those with history of fracture, the 10-year absolute risk of any fracture in men ranged from 1.0 vs. 1.2% at age 40 years to 3.0 vs. 4.4% at age 75 years. The respective estimates in women ranged from 0.7 vs. 1.0% at age 40 years to 9.3 vs. 17.2% at age 75 years. Statistically significant interaction between age and sex was found (P < 0.001), which contributed to the differences in predicted absolute fracture risks for men and women at different ages. Our study shows the need for population-specific data to develop efficient well calibrated algorithms for assessment of fracture risk. The interaction observed between sex and age points to the need for further prospective studies among men.     

Body mass and risk of hip fracture among a national cohort of postmenopausal white women: a reanalysis

To assess the prospective relationship between body mass and rate of hip fracture, we analyzed data from 2,285 postmenopausal women, aged 50-77 years, who responded to the first National Health and Nutrition Examination Survey (NHANES I) in 1971-1974 and the 1982-84 interview of the National Health Epidemiologic Follow-up Study (NHEFS). We plan to add to the previous analysis of these same data by Farmer et al. by 1) including retrospective information on estrogen replacement therapy; 2) increasing the follow-up time by 5 years and using only hospital-verified cases of hip fracture from the 1987 Health Care Facilities Stay data tape; and 3) limiting the analysis to postmenopausal white women, ages 50-77 years. Results of the multivariable Cox regression modeling showed that women with a baseline body mass index in the highest quartile (> 37 kg/m1.5) experienced a 70% lower rate of hip fracture compared with women in the lowest quartile (< or = 28.7 kg/m1.5)(RR=0.32; 95%CI:0.12, 0.82). Age was positively related to the risk of hip fracture, with the rate over 20% higher per year of age (RR=1.21; 95%CI:1.13, 1.29). Although reported education level, smoking history, physical activity level, and estrogen replacement were significantly (p < 0.0001) associated with body mass index, these covariates were not related to hip fracture in the multivariable analysis. Our findings corroborate earlier results using this same data source, and suggest that interventions aimed at preserving lean mass and consequent bone integrity should be encouraged among women before menopause and maintained through older adulthood.     

Suicide risk in relation to level of urbanicity--a population-based linkage study

BACKGROUND: The extent to which the high suicide rate in urban areas is influenced by exposures to risk factors for suicide other than urbanicity remains unknown. This population-based study aims to investigate suicide risk in relation to the level of urbanicity in the context of other factors, and to study the risk variation in a sex, age, and calendar year perspective. METHODS: The study is a nested case-control study comprising 21 169 suicides and 423 128 population controls matched for age and sex. Personal data on place of residence, socioeconomic status and psychiatric history were retrieved from various Danish longitudinal registers. Data were analysed with conditional logistic regression. RESULTS: This study confirms that people living in more urbanized areas are at a higher risk of suicide than their counterparts in less urbanized areas. However, this excess risk is largely eliminated when adjusted for personal marital, income, and ethnic differences; it is even reversed when further adjusted for psychiatric status. Moreover, the impact of urbanicity on suicide risk differs significantly by sex and across age. Urban living reduces suicide risk significantly among men, especially young men, but increases the risk among women, especially women aged 24-35 or >65 years. In addition, during 1981-1997, the suicide risk associated with urbanicity remained rather constant among women, whereas it dropped significantly among men, a trend that seemingly gained strength during the last part of this period. CONCLUSIONS: Suicide risk associated with urbanicity varies significantly by sex and age groups and recent years have seen a decline in the urban-rural disparities among men. The increased risk in urban areas can largely be explained by the effects of marital status, ethnics, income, and psychiatric status.     

非综合性唇腭裂危险因素的条件logistic回归分析

目的 探索非综合征性唇腭裂患儿孕母早期接触的环境危险因素对唇腭裂发生的影响。方法 采用1∶1配对病例对照研究,对母亲孕早期接触的环境危险因素做条件logistic回归。采用EpiData 3.0建立数据库,应用SPSS 19.0软件统计、分析数据。结果 共收集252份问卷,单因素logistic 回归分析得到22个因素有统计学意义。多因素条件logistic 回归分析得到7个因素有统计学意义:母亲孕龄（P = 0.04,OR = 0.92）,文化程度（P＜0.01,OR = 11.86）,孕早期叶酸补充史（P = 0.01,OR = 0.21）,孕期钙补充史（P＜0.01,OR = 0.15）,吸烟及被动吸烟史（P＜0.01,OR = 7.62）,居住房屋新装修（半年之内）史（P = 0.01,OR = 5.41）。结论 为预防非综合性唇腭裂孕妇尽量避免吸二手烟,孕前3个月定时定量补充叶酸、钙等,避免孕早期精神压力过大。