老年膝髋关节置换术后医院感染的危险因素分析

Analysis of Risk Factors for Hospital Infection after Knee and Hip Arthroplasty in the Elderly

目的:探究老年膝髋关节置换术后医院感染的危险因素。方法:回顾性分析2019年1月—2022年1月东南大学附属中大医院120例老年膝髋关节置换术后患者的临床资料。统计所有患者术后医院感染发生情况,收集所有患者一般资料。对老年膝髋关节置换术后医院感染进行单因素及多因素分析。结果:120例老年膝髋关节置换术后患者中,有16例患者发生医院感染,占比为13.33%。其中医院感染发生部位以呼吸道为主,占6例(37.50%),其次为泌尿道4例(25.00%)、手术切口3例(18.75%)、皮肤软组织2例(12.50%)、假体周围深部1例(6.25%)。单因素分析显示,感染患者超重或肥胖、糖尿病史、术前白蛋白≤35 g/L、术前无抗生素预防性应用、术后引流>48 h占比均高于未感染患者(P<0.05)。logistic回归分析显示,体重指数、糖尿病史、术前白蛋白水平、术前抗生素预防性应用、术后引流时间均为老年膝髋关节置换术后患者医院感染的高危因素(P<0.05)。结论:老年膝髋关节置换术后发生医院感染的危险因素众多,包括体重指数、糖尿病史、术前白蛋白水平、术前抗生素预防性应用、术后引流时间,术前做好评估与预防工作、术后采取针对性护理对策均有助于降低术后医院感染率。

Objective: To explore the risk factors for hospital infection after knee and hip arthroplasty in the elderly. Method: The clinical data of 120 elderly patients after knee and hip arthroplasty in Zhongda Hospital Southeast University from January 2019 to January 2022 were retrospectively analyzed. The occurrence condition of postoperative hospital infection of all patients was counted, and the general information of all patients was collected. The hospital infection after knee and hip arthroplasty in elderly was analyzed by single factor and multi factor. Result: Among 120 elderly patients after knee and hip arthroplasty, 16 patients had hospital infection, accounting for 13.33%. The main occurrence site of hospital infection was respiratory tract, accounting for 6 cases(37.50%), followed by urinary tract in 4 cases(25.00%), surgical incision in 3 cases(18.75%), skin and soft tissue in 2 cases(12.50%), and deep around the prosthesis in 1case(6.25%). Univariate analysis showed that the proportions of overweight or obesity, history of diabetes, preoperative albumin ≤35 g/L,no preoperative antibiotics prophylactic application, and postoperative drainage >48 h in infected patients were higher than those in noninfected patients(P<0.05). logistic regression analysis showed that body mass index, history of diabetes, preoperative albumin level,preoperative antibiotic prophylactic application and postoperative drainage time were all high risk factors for hospital infection in elderly patients after knee and hip arthroplasty(P<0.05). Conclusion: There are many risk factors for the occurrence of hospital infection in the elderly after knee and hip arthroplasty, including body mass index, history of diabetes, preoperative albumin level, preoperative antibiotic prophylactic application, postoperative drainage time. Preoperative assessment and prevention work, and postoperative taking targeted nursing measures are helpful to reduce the postoperative hospital infection rate.