关节置换术患者手术部位感染危险因素的荟萃分析

Risk factors for surgical site infections in patients undergoing total joint replacement:a meta-analysis

目的分析关节置换(TJR)患者发生手术部位感染(SSI)的危险因素,为制定感染控制策略提供依据。方法计算机检索CNKI、万方、VIP、CBM、Pubmed、Embase、Web of Science、Cochrane数据库文献,由两名评价员根据纳入及排除标准独立筛选文献、提取数据和质量评价后,用RevMan5.3软件进行荟萃分析。结果纳入18篇文献,关节置换患者3479例,合并手术部位感染798例。荟萃分析结果显示:长期使用激素(OR=4.46)、有关节手术史(OR=4.14)、合并非手术区域感染(OR=9.42)、术后伤口血肿或开裂(OR=5.62)、手术时间长(SMD=0.93)是TJR患者发生SSI的重要危险因素(P<0.05)。结论 TJR患者发生SSI的危险因素纷繁复杂,只有对相关危险因素进行综合干预,才能有效预防和控制感染的发生。

OBJECTIVE To investigate the risk factors for surgical site infections（SSI）in patients undergoing total joint replacement（TJR）so as to put forward the strategies for control of the infections.METHODS The databases including CNKI,Wanfang,VIP,CBM,Pubmed,Embase,Web of Science and Cochrane were retrieved by computers.On the basis of the inclusion and exclusion criteria,the literatures were screened independently by two reviewers,the data were extracted,the quality was evaluated,and the meta-analysis was performed with the use of RevMan5.3 software.RESULTS Totally 18 literatures were included,involving 3479 TJR patients and 798 patients complicated with SSI.The result of the meta-analysis indicated that the major risk factors for SSI in the TJR patients included the long-term use of hormones（OR=4.46）,history of joint surgery（OR=4.14）,complication with non-surgical area infections（OR=9.42）,postoperative wound hematoma or cracking（OR=5.62）and long operation duration（SMD=0.93）（P0.05）.CONCLUSIONThere are a variety of risk factors for SSI in the TJR patients.Only the comprehensive interventions are taken to the related risk factors can the infections be prevented and controlled effectively.