老年髋部骨折患者围手术期护理质量指标与术后并发症的相关性研究

Correlation Study between Perioperative Nursing Quality Indicators and Postoperative Complications in Elderly Patients with Hip Fracture

摘要: 目的：构建老年髋部骨折患者围手术期护理质量指标体系，探讨各指标与术后并发症的相关性，为优化护理干预、降低并发症发生率提供循证依据。方法：选取2023年1月至2024年12月在本院接受手术治疗的186例老年髋部骨折患者为研究对象，依据《三级医院老年髋部骨折围手术期护理专家共识(2026)》构建包含术前、术中、术后3个维度12项核心护理质量指标的评估体系，采用回顾性分析结合前瞻性监测方法，收集患者护理质量指标数据及术后并发症发生情况，通过Pearson相关分析、多因素Logistic回归模型分析护理质量指标与术后并发症的相关性。结果：186例患者中术后并发症发生率为18.82% (35例)，主要包括肺部感染、静脉血栓栓塞症、压疮及泌尿系统感染。单因素分析显示，术前营养评估合格率、深静脉血栓预防措施落实率、术中体位护理准确率、术后疼痛控制达标率、早期康复训练实施率等8项指标与术后并发症发生相关(P < 0.05)。多因素Logistic回归分析表明，术前营养评估合格率(OR = 0.326, 95% CI: 0.158~0.673)、术后疼痛控制达标率(OR = 0.289, 95% CI: 0.134~0.622)、早期康复训练实施率(OR = 0.301, 95% CI: 0.142~0.637)为术后并发症发生的保护因素，而术中体温管理不到位(OR = 3.125, 95% CI: 1.456~6.712)、术后压疮预防措施落实不规范(OR = 2.874, 95% CI: 1.328~6.211)为危险因素。结论：老年髋部骨折患者围手术期护理质量与术后并发症密切相关，强化术前营养评估、规范术中体温管理、落实术后疼痛控制及早期康复训练等核心指标的管控，可有效降低术后并发症风险，改善患者预后。

Abstract: Objective: To construct a perioperative nursing quality indicator system for elderly patients with hip fractures and investigate the correlation between these indicators and postoperative complications, so as to provide evidence-based guidance for optimizing nursing interventions and reducing complication rates. Methods: A total of 186 elderly hip fracture patients who underwent surgery in our hospital from January 2023 to December 2024 were enrolled. Based on the Expert Consensus on Perioperative Nursing for Elderly Hip Fractures in Tertiary Hospitals (2026), a 12-item core nursing quality indicator system was developed, covering preoperative, intraoperative, and postoperative dimensions. Data on nursing quality indicators and postoperative complications were collected retrospectively and prospectively. Pearson correlation analysis and multivariate logistic regression models were used to evaluate the correlation between nursing quality indicators and postoperative complications. Results: The overall postoperative complication rate was 18.82% (35/186), with the most common complications being pulmonary infections, venous thromboembolism (VTE), pressure injuries, and urinary tract infections. Univariate analysis revealed that 8 indicators, including the compliance rate of preoperative nutritional assessment, implementation rate of VTE prophylaxis, accuracy of intraoperative positioning care, achievement rate of postoperative pain control, and implementation rate of early rehabilitation training, were significantly associated with postoperative complications (P < 0.05). Multivariate logistic regression analysis identified the following protective factors: compliance rate of preoperative nutritional assessment (OR = 0.326, 95% CI: 0.158~0.673), achievement rate of postoperative pain control (OR = 0.289, 95% CI: 0.134~0.622), and implementation rate of early rehabilitation training (OR = 0.301, 95% CI: 0.142~0.637). Conversely, inadequate intraoperative temperature management (OR = 3.125, 95% CI: 1.456~6.712) and substandard implementation of postoperative pressure injury prevention measures (OR = 2.874, 95% CI: 1.328~6.211) were identified as risk factors. Conclusion: Perioperative nursing quality is closely correlated with postoperative complications in elderly hip fracture patients. Strengthening the management of core indicators—such as preoperative nutritional assessment, standardized intraoperative temperature management, effective postoperative pain control, and early rehabilitation training—can significantly reduce the risk of complications and improve patient outcomes.