骨科患者术后感染危险因素及围术期血清C反应蛋白、白蛋白水平监测价值分析

The risk factors for postoperative infection in orthopedic patients and the significance of monitoring perioperative serum CRP and ALB levels

目的探讨骨科患者术后感染的相关因素,分析患者围术期血清C反应蛋白(CRP)、白蛋白(ALB)及其比值水平与围术期感染的关系。方法我院择期行手术治疗的骨科患者128例,根据术后是否发生感染分为感染组(n=43)与未感染组(n=85)。比较两组一般临床资料和手术指标,分析骨科患者术后出现感染的可能危险因素;比较两组不同时间点血清CRP、ALB水平,CRP/ALB比值,评价各指标对骨科患者术后感染的诊断价值。结果感染组年龄≥60岁、合并糖尿病、开放性骨折、美国麻醉医师协会(ASA)分级Ⅲ级、切口类型Ⅲ类、手术时间≥2 h、术后住院时间≥7 d、抗菌药物使用种类≥2种、导尿操作和置入物占比高于未感染组(P<0.05);年龄≥60岁、手术时间≥2 h、术后住院时间≥7 d、抗菌药物使用种类≥2种和存在置入物是骨科患者术后发生感染的独立危险因素(P<0.05);术后3 d,观察组血清CRP水平和CRP/ALB比值高于对照组,血清ALB水平低于对照组(P<0.05);CRP、ALB和CRP/ALB比值的曲线下面积(AUC)分别为0.838、0.780和0.863,对骨科患者术后发生感染均具有诊断价值,且CRP/ALB比值的诊断价值高于单一指标(P<0.05)。结论骨科患者术后发生感染由多个因素协同作用导致,高龄、ASA分级、手术时间≥2 h、术后住院时间≥7 d、抗菌药物使用种类≥2种和存在置入物是骨科患者术后发生感染的独立危险因素,临床可通过监测围术期间血清CRP、ALB水平和CRP/ALB比值对患者术后感染进行早期诊断,并积极干预以降低术后感染发生风险。

Objective To explore the related factors of postoperative infection in orthopedic patients,and analyze the relationship between perioperative serum C-reactive protein(CRP),albumin(ALB),their ratio and the infection.Methods A total of 128 orthopedic patients undergoing elective surgical treatment in our hospital were enrolled.According to the presence or absence of postoperative infection,they were divided into infected group(n=43)and non-infected group(n=85).The general clinical data and surgical indicators of the two groups were compared,and possible risk factors of postoperative infection in orthopedic patients were screened.Serum CRP and ALB levels and CRP/ALB ratios in the two groups at different time points were compared.The diagnostic value of each index for postoperative infection in orthopedic patients was evaluated.Results The percentages of patients who were≥60 years old and had diabetes,open fractures,American Society of Anesthesiologists(ASA)grade III,type III incision,operation time≥2 hours,postoperative hospital stay≥7 days,use antibiotics≥2,urine catheterization and implantation in the infected group were significantly higher than those in the non-infected group(P<0.05).Multivariate logistic analysis showed that age≥60 years old,operation time≥2 hours,postoperative hospital stay≥7 days,use of antibiotics≥2 and the presence of implants were independent risk factors for postoperative infection in orthopedic patients(P<0.05).After 3 days of surgery,serum CRP levels and CRP/ALB ratio of the experiment groupwere significantly higher,while ALB levels were significantly lowerthan those of the control group(P<0.05).ROC curve analysis showed that the area under curve(AUC)of CRP,ALB and CRP/ALB ratio were 0.838,0.780 and 0.863,respectively.These indicated that all three indicators had a diagnostic value for postoperative infection(P<0.05).Besides,the diagnostic value of CRP/ALB ratio was higher than that of each index alone.Conclusion The postoperative infection in orthopedic patients is caused by the synergistic effect of multiple factors.Old age,ASA classification,operation time≥2 hours,postoperative hospital stay≥7days,use of antibiotics≥2,and the presence of implants are independent risk factors for postoperative infection.Clinically,early diagnosis of postoperative infection may be achievedby monitoring serum CRP and ALB levels and CRP/ALB ratio during the perioperative period,.Active intervention measures should be taken to reduce the risk of postoperative infection.