老年关节置换术患者假体周围感染现状及影响因素研究

Current status of periprosthetic infection in elderly patients undergoing arthroplasty and influencing factors

目的了解和掌握老年关节置换术患者假体周围的感染情况,分析导致患者感染的危险因素为临床预防感染提供参考依据。方法选取2010年12月-2015年10月医院临床收治的关节置换术患者392例,对患者临床资料、手术资料、血清检查结果与患者假体周围感染率关系进行比较研究。结果 392例关节置换术患者中发生假体周围感染的患者35例,感染率为9.18%;年龄≥65岁患者的感染率为15.97%,高于<65岁患者的6.23%;合并并发症数量≥2种患者的感染率为39.13%,高于<2种患者的7.32%;使用免疫抑制剂患者的感染率为19.39%,高于未使用患者的5.78%;抗菌药物使用时间<7d患者的感染率为17.07%,高于≥7d患者的8.26%;无菌操作不规范患者的感染率为40.98%,高于无菌操作规范患者的3.32%;手术时间≥2h患者的感染率为15.08%,高于<2h患者的6.39%;空腹血糖异常患者的感染率为22.95%,高于空腹血糖正常患者的6.65%,组间比较差异有统计意义(P<0.05)。结论导致老年关节置换术患者假体周围感染的临床危险因素较多,在临床实践过程中应针对危险因素采取积极有效的预防措施来降低感染率。

OBJECTIVE To understand the prevalence of periprosthetic infection in elderly patients undergoing ar- throplasty and analyze the risk factors for the infection so as to provide guidance for clinical prevention of the infec- tion. METHODS A total of 392 patients who received the arthroplasty in the hospital from Dec 2010 to Oct 2015 were enrolled in the Study. The correlation between the clinical data, surgical data, result of serological examina- tion and the incidence of periprosthetic infection was observed. RESULTS Of the 392 patients who underwent the arthroplasty, 35 had periprosthetic infection, with the infection rate 9.18 %. The infection rate was 15.97 % in the patients aged no less than 65 years old, higher than 6.23% in the patients aged less than 65 years old; the infec- tion rate was 39.13% in the patients complicated with no less than 2 kinds of diseases, higher than 7.32% in the patients complicated with less than 2 kinds of diseases; the infection rate was 19.39 % in the patients who used im- munosuppressants, higher than 5.78% in the patients who did not use; the infection rate was 17.07% in the pa- tients who used antibiotics for less than 7 days, higher than 8.26 % in the patients who used antibiotics for no less than 7 days; the infection rate was 40.98% in the patients who were treated with nonstandard aseptic operations, higher than 3. 32% in the patients who were treated with standard aseptic operations; the infection rate was 15.08% in the patients with operation duration no less than 2 hours, higher than 6. 39% in the patients with oper- ation duration less than 2 hours; the infection rate was 22.95% in the patients with abnormal fasting blood glu- cose, higher than 6.65% in the patients with normal fasting blood glucose, and there was significent difference （P〈0.05）. CONCLUSION There are a variety of risk factors for the periprosthetic infeetion in the elderly patients undergoing arthroplasty. It is necessary to take effectlve prevention measures aiming at the risk factors during clini- cal practice so as to reduce the infection rate.