开放性骨折患者低白蛋白血症与手术部位感染的相关性

Relationship of hypoalbuminemia and surgical site infections in patients with open fractures

目的探讨开放性骨折患者入院时低白蛋白血症与术后手术部位感染发生的关系。方法回顾性分析2017年1月-2020年10月苏州大学附属无锡九院重症医学科收治的符合纳入标准的166例开放性骨折患者病例资料,按入院时是否存在低白蛋白血症分为低白蛋白血症组(n=114)和正常组(n=52)。比较两组患者人口学和临床特征,应用多因素Logistic回归模型分析造成患者发生手术部位感染的影响因素。结果低白蛋白血症组和正常组开放性骨折患者平均年龄(t=1.885,P=0.061)、性别构成(χ^(2)=0.038,P=0.846)、入院时中位简明创伤评分(AIS)(U=0.464,P=0.052)、平均动脉压(t=1.943,P=0.052)差异均无统计学意义。但两组患者从发病到入院时间(U=2.141,P=0.032)、入院时平均血清白蛋白水平(t=18.975,P=0.005)和手术部位感染发生率(33.33%和7.69%;χ^(2)=12.42,P=0.004)差异均有统计学意义。多因素Logistic回归分析发现,性别、年龄、从发病至入院时间、平均动脉压、入院时AIS评分均对开放性骨折患者手术部位感染发生均无影响(P>0.05),低白蛋白血症是导致开放性骨折患者发生手术部位感染的危险因素(P<0.05)。结论入院时存在低蛋白血症,开放性骨折患者更易发生手术部位感染。

Objective To investigate the relationship between hypoalbuminemia and surgical site infections in patients with open fractures.Methods The medical records of 166 eligible patients with open fractures meeting the inclusion and exclusion criteria that were admitted to Department of Intensive Care Unit,Wuxi 9 th Hospital Affiliated to Soochow University during the period from January 2017 to October 2020 were retrospectively reviewed.All patients were assigned into the hypoalbuminemia group(n=114)and normal group(n=52)according to the presence of hypoalbuminemia at admission.The demographic and clinical features were compared between two groups,and multivariate logistic regression analysis was performed to identify factors affecting surgical site infections.Results There were no significant differences between the hypoalbuminemia and normal groups in terms of mean age(54.89±12.49 vs.48.67±13.31 years;t=1.885,P=0.061),gender ratio(102/12 vs.46/6;χ^(2)=0.038,P=0.846),admission median abbreviated injury score[6(1)vs.6(2);U=0.464,P=0.052]and mean arterial pressure(84.11±16.19 vs.73.33±26.52 mmHg;t=1.943,P=0.052).However,there were significant differences in the duration from onset to admission[2(4)vs.4(4)h;U=2.141,P=0.032],mean admission serum albumin level(25.76±5.24 vs.39.19±3.96 g/L;t=18.975,P=0.005)and incidence of surgical site infections(33.33%vs.7.69%;χ^(2)=12.42,P=0.004).In addition,multivariate logistic regression analysis revealed that gender(P=0.072,OR=0.523,95%CI:0.258~1.060),age(P=0.723,OR=0.996,95%CI:0.971~1.020),duration from onset to admission(P=0.495,OR=1.042,95%CI:0.926~1.172),mean arterial pressure(P=0.191,OR=0.986,95%CI:0.966~1.007)and admission AIS score(P=0.643,OR=1.037,95%CI:0.891~1.206)had no effects on surgical site infections for open fracture surgery in patients with open fractures,while hypoalbuminemia was identified as a risk factor for surgical site infections in patients with open fractures(P=0.039,OR=4.018,95%CI:1.075~15.022).Conclusion Open fracture patients with hypoalbuminemia at admission are more likely to develop surgical site infections,and hypoalbuminemia is a risk factor for surgical site infections in patients with open fractures(P=0.039,OR=4.018,95%CI:1.075~15.022).