人工髋关节置换术后慢性感染的危险因素分析

摘要

Objective To analyze the risk factors of chronic infection after total hip replacement,and to provide more reference for reducing postoperative infection rate.Methods A retrospective analysis was made in 1021 patients of joint hip arthroplasty from January 2012 to June 2016 in our hospital.The patients of postoperative chronic infection was the observation group,and the patients with no postoperative chronic infection was the control group.Gender,age,operation time,blood glucose,surgery the content of hemoglobin,preoperative serum albumin and other factors of the patients were compared and statistical analyzed.Results 13 cases of chronic infection in 1021 patients after total hip arthroplasty.The postoperative infection rate was 1.27%.13 strains of bacteria were detected as follows: Staphylococcus aureus (38.46%),Escherichia coli (23.07%),Pseudomonas aeruginosa (15.38%),Staphylococcus epidermidis (7.69%),Klebsiella pneumoniae (7.69%),Candida albicans (7.69%).The risk factors of chronic infection after total hip replacement were mainly operative time,blood glucose,hemoglobin content,preoperative preoperative serum albumin (P<0.05).After multivariate Logistic regression analysis,the patient''s operation time,blood glucose,preoperative hemoglobin and preoperative serum albumin were the risk factors of infection after artificial hip replacement.Conclusion There are many risk factors for hip arthroplasty after a chronic infection,including patients age,operation time,preoperative serum albumin.Effective preventive measures should beusedaccording to the risk factors in order to reduce the incidence of chronic infection.%目的 分析人工髋关节置换术后慢性感染的危险因素,为降低患者术后感染率提供更多参考依据.方法 回顾性分析2012年1月至2016年6月于我院关节外科就诊的行人工髋关节置换术的患者1 021例,以术后发生慢性感染的患者为观察组,以术后未发生慢性感染的患者为对照组,对两组患者的性别、年龄、手术时间、血糖、术前血红蛋白含量、术前血清白蛋白等因素进行对比分析.结果 1 021例人工髋关节置换术患者术后发生慢性感染13例,术后感染率为1.27%;共检验出病原菌13株,依次为金黄色葡萄球菌5株(38.46%)、大肠埃希菌3株(23.07%)、铜绿假单胞菌2株(15.38%)、表皮葡萄球菌1株(7.69%)、肺炎克雷伯菌1株(7.69%)、白色假丝酵母菌1株(7.69%);观察组与对照组在手术时间、血糖、术前血红蛋白含量以及术前血清白蛋白等方面比较,差异均有统计学意义(P<0.05).经多因素Logistic回归分析,患者的手术时间、血糖、术前血红蛋白、术前血清白蛋白是人工髋关节置换术后感染发生的危险因素.结论 人工髋关节置换术后慢性感染的危险因素较多,主要包括患者高龄、手术时间、术前血红蛋白、术前血清白蛋白等,可根据危险因素采取有针对性的预防措施降低慢性感染发生率.