关节置换术患者不同剂量万古霉素骨水泥占位器预防感染的疗效研究

摘要

Objective To evaluate the efficacy of different doses of vancomycin bone cement for patients with joint replacement.Methods Totally 283 patients who accepted the joint replacement for the first time from January 2013 to March 2015 in the hospital were included and analyzed retrospectively.Results Totally 206 patients used 1 000 mg vancomycin bone cement to prevent infection,and the other 77 patients used 2 000 mg.There was no significant difference in the age,weight,the number of diabetes,initial diagnosis,the HSS scores before or after operation (P ＞ 0.05).The result of logistic analysis showed that dose of vancomycin bone cement,gender,body weight,basic diagnosis and length of hospital stay had no influence on the incidence of infection after joint replacement.However diabetes is a risk factor of infection.Conclusion There is no significant difference in the recurrence of infection between prophylactic use of 1 000 mg and 2 000 mg vancomycin bone cement in patients receiving joint replacement for the first time.To reduce the adverse reactions of antibiotic drugs and the economic burden of patients,1 000 mg prophylactic use of vancomycin bone cement should be suggested.%目的 探讨不同剂量万古霉素骨水泥对膝关节置换患者术后感染的影响.方法 回顾性调查研究某医院骨科2013年1月至2015年3月283例初次膝关节置换术的病例.结果 共纳入283例初次膝关节置换术的病例,其中206患者在术中使用1 000mg万古霉素抗生素骨水泥,另外77例患者在术中使用2000 mg万古霉素抗生素骨水泥.两组患者的年龄、体重、糖尿病、初始诊断、HSS术前术后评分、住院时间比较差异无统计学意义(P＞0.05);采用双项Logistic相关性分析膝关节置换患者感染因素,显示不同剂量万古霉素、性别、体重、基础诊断、住院天数对膝关节置换后感染无影响,而糖尿病是膝关节置换术后感染的高危因素.结论 初次膝关节置换患者预防性应用1 000mg或2000 mg万古霉素骨水泥,在术后再发感染方面无显著差异,为减少抗菌药物不良反应和减轻患者治疗经济负担,可预防性应用1 000mg万古霉素骨水泥.