红细胞储存时间长短对全髋关节置换术后感染的危险性分析

Influence of red blood cell storage duration on infections after total hip arthroplasty

目的探讨接受输血治疗的全髋关节置换患者中红细胞储存时间的长短对患者术后感染情况的影响。方法选取医院2013年5月-2016年5月接受输血治疗的全髋关节置换患者74例,根据所输红细胞储存时间将患者分为对照组(储存时间<14d)31例和研究组(储存时间≥14d)43例,对比分析两组患者的临床资料、术后感染、病原学及耐药性等。结果研究组术后手术部位感染比例显著高于对照组(P<0.05),术后并发感染的患者总数也显著高于对照组(P<0.05);多因素logistic回归分析发现,红细胞储存时间≥14d是全髋关节置换术后患者并发感染的危险因素;革兰阳性菌以金黄色葡萄球菌为主,革兰阴性菌以大肠埃希菌为主;革兰阳性菌对青霉素及莫西沙星耐药率较高,分别为90.00%和80.00%,革兰阴性菌对磺胺甲噁唑/甲氧苄啶耐药率达90.32%。结论输注储存时间≥14d的红细胞是全髋关节置换术后患者并发感染的独立危险因素。

OBJECTIVE To explore the influence of red blood cell（RBC）storage duration on postoperative infections in total hip arthroplasty patients who were treated with blood transfusion.METHODS A total of total hip arthroplasty patients who received blood transfusion in the hospital from May 2013 to May 2016 were enrolled in the study and divided into the control group with 31cases（the storage time less than 14days）and the study group with 43cases（the storage time no less than 14days）according to the storage duration of RBC.The clinical data,incidence of postoperative infection,etiological characteristics,and drug resistance rates were observed and compared between the two groups of patients.RESULTS The proportion of the patients with postoperative surgical site infections was significantly higher in the study group than in the control group（P〈0.05）,the total number of the patients complicated with postoperative infections was also significantly greater in the study group than in the control group（P〈0.05）.Multivariate logistic regression analysis showed that the no less than 14 days of RBC storage duration was the risk factor for the postoperative infections in the total hip arthroplasty patients.Staphylococcus aureus was the predominant species of gram-positive bacteria,and Escherichia coli was dominant among the gram-negative bacteria.The drug resistance rates of the gram-positive bacteria to penicillin and moxifloxacin were90.00% and 80.00%,respectively;the drug resistance rate of the gram-negative bacteria to sulfamethoxazole-trimethoprim was as high as 90.32%.CONCLUSIONThe no less than 14 days of RBC storage duration is the independent risk factor for the postoperative complication with infections in the total hip arthroplasty patients.