风湿病患者人工膝关节置换术后院内感染的风险因素分析

Risk factors for nosocomial infections after total knee replacement

目的 探讨人工膝关节置换 (TKR)患者院内感染的风险因素。 方法 对 1988年 8月～ 1998年 10月收治的 36 3例 5 0 3个人工膝关节置换中不同年龄和原发病种类、不同伴发疾病等情况中医院感染的发生情况进行统计分析。 结果 类风湿性关节炎与骨性关节炎患者TKR术后院内感染发病率差异无显著性意义 (P >0 0 5 ) ;返修术者、服用激素者及糖尿病患者的院内感染率明显高于一般TKR患者 (P <0 0 1) ;双膝TKR术后院内感染率与一般TKR术后相比差异无显著性意义 (P >0 0 5 )。各种感染中 ,泌尿系感染 2 8例 (占 7 7% ) ,均为女性 ,明显高于其它系统感染 (P >0 0 5 )。 结论 风湿病患者TKR术后院内感染的发生 ,与患者是否服用激素、是否伴发糖尿病、既往是否有TKR手术史以及高龄女性患者术后留置尿管等多因素有关 ,对此类患者宜采取相应措施 。

Objective To investigate prevalence and risk factors of nosocomial infections in patients with total knee replacement. Methods From August 1993 to October 1998, total knee replacement was performed on 363 patients (503 knees). The difference of nosocomial infection rates was statistically analyzed in comparison with different age, primary disease, and associated disease groups. Results No statistically significant difference was observed in nosocomial infection when compared rheumatoid arthritis with osteoarthritis, bilateral total knee replacement (TKR) with unilateral TKR and different ages. However,the higher nosocomial infection rate was nelated to the following factors: revision surgery, steroid administration and diabetes urinary infection. 28 female patients demonstrated higher urinary infection rate than that in other systems. Conclusions Nosocomial infection rate of TKR in rheumatoid cases is related to steroid administration, accompanying diabetes mellitas, previous knee surgery, aged women and retention of urinary catheter. It is feasible to prevent nosocomial infection by controlling the above mentioned risk factors.