高龄全髋关节置换患者术后肺部感染与血清炎性因子的变化研究
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摘要
目的探讨高龄患者全髋关节置换术后肺部感染与血清炎性因子的变化,为术后肺部感染的防治提供参考。方法选取2015年1月-2017年12月在医院行全髋关节置换术的高龄患者120例,观察患者术后肺部感染发生情况,采集感染患者痰液标本行细菌培养、分离及鉴定,检测患者术前、术后3d血清肿瘤坏死因子α(TNF-α)、白细胞介素-1、2、6、8、10(IL-1、IL-2、IL-6、IL-8、IL-10)、C-反应蛋白(CRP)等炎性因子水平。结果术后21例患者发生肺部感染,感染率为17.50%,共分离病原菌23株,其中革兰阴性菌15株、革兰阳性菌8株。患者术后3d血清TNF-α、IL-1、IL-6、IL-8、IL-10、CRP均高于术前,IL-2低于术前,比较差异有统计学意义(P<0.05);术后肺部感染与未感染患者术前血清炎症因子比较差异无统计学意义;术后3d肺部感染患者血清TNF-α、IL-1、IL-6、IL-8、IL-10、CRP分别为(35.16±14.44)pg/ml、(74.35±21.34)pg/ml、(98.05±34.62)pg/ml、(62.46±21.81)pg/ml、(35.23±7.90)pg/ml、(31.72±3.45)g/L,高于未感染患者(P<0.05),IL-2为(143.68±42.14)pg/ml低于未感染患者(P<0.05)。结论全髋关节置换高龄患者术后容易发生肺部感染,术后早期检测血清炎性因子水平有助于预测及诊断肺部感染。
OBJECTIVE To explore the correlation between the postoperative pulmonary infection and the serum inflammatory factors of the elderly patients undergoing total hip arthroplasty so as to provide guidance for prevention and treatment of the postoperative pulmonary infection.METHODS A total of 120 elderly patients who underwent the total hip arthroplasty in hospitals from Jan 2015 to Dec 2017 were enrolled in the study,the incidence of postoperative pulmonary infection was observed,the sputum specimens were collected from the patients with the infection,the bacterial culture,isolation and identification were carried out,and the levels of serum inflammatory factors,including tumor necrosis factorα(TNF-α),interleukin-1,2,6,8,10(IL-1,IL-2,IL-6,IL-8,IL-10)and C-reactive protein(CRP)were determined before the surgery and after the surgery for 3 days.RESULTS Totally 21 patients had postoperative pulmonary infection,with the infection rate 17.50%.A total of 23 strains of pathogens were isolated,15 of which were gram-negative bacteria,and 8 were gram-positive bacteria.The levels of serum TNF-α,IL-1,IL-6,IL-8,IL-10 and CRP of the patients were higher after the surgery for 3 days than before the surgery,while the IL-2 level was significantly lower after the surgery for 3 days than before the surgery(P<0.05).There were no significant differences in the levels of serum inflammatory factors between the patients with postoperative pulmonary infection and the patients without infection before the surgery;the levels of serum TNF-α,IL-1,IL-6,IL-8,IL-10 and CRP of the patients with pulmonary infection were respectively(35.16±14.44)pg/ml,(74.35±21.34)pg/ml,(98.05±34.62)pg/ml,(62.46±21.81)pg/ml,(35.23±7.90)pg/ml and(31.72±3.45)g/L after the surgery for 3 days,significantly higher than those of the patients without infection(P<0.05);the IL-2 level of the patients with pulmonary infection was 143.68±42.14)pg/ml,significantly lower than that of the patients without infection(P<0.05).CONCLUSIONThe elderly patients are prone to have pulmonary infection after the total hip arthroplasty,and the postoperative detection of the serum inflammatory factors in early stage may facilitate the diagnosis of pulmonary infection.
OBJECTIVE To explore the correlation between the postoperative pulmonary infection and the serum inflammatory factors of the elderly patients undergoing total hip arthroplasty so as to provide guidance for prevention and treatment of the postoperative pulmonary infection.METHODS A total of 120 elderly patients who underwent the total hip arthroplasty in hospitals from Jan 2015 to Dec 2017 were enrolled in the study,the incidence of postoperative pulmonary infection was observed,the sputum specimens were collected from the patients with the infection,the bacterial culture,isolation and identification were carried out,and the levels of serum inflammatory factors,including tumor necrosis factorα(TNF-α),interleukin-1,2,6,8,10(IL-1,IL-2,IL-6,IL-8,IL-10)and C-reactive protein(CRP)were determined before the surgery and after the surgery for 3 days.RESULTS Totally 21 patients had postoperative pulmonary infection,with the infection rate 17.50%.A total of 23 strains of pathogens were isolated,15 of which were gram-negative bacteria,and 8 were gram-positive bacteria.The levels of serum TNF-α,IL-1,IL-6,IL-8,IL-10 and CRP of the patients were higher after the surgery for 3 days than before the surgery,while the IL-2 level was significantly lower after the surgery for 3 days than before the surgery(P<0.05).There were no significant differences in the levels of serum inflammatory factors between the patients with postoperative pulmonary infection and the patients without infection before the surgery;the levels of serum TNF-α,IL-1,IL-6,IL-8,IL-10 and CRP of the patients with pulmonary infection were respectively(35.16±14.44)pg/ml,(74.35±21.34)pg/ml,(98.05±34.62)pg/ml,(62.46±21.81)pg/ml,(35.23±7.90)pg/ml and(31.72±3.45)g/L after the surgery for 3 days,significantly higher than those of the patients without infection(P<0.05);the IL-2 level of the patients with pulmonary infection was 143.68±42.14)pg/ml,significantly lower than that of the patients without infection(P<0.05).CONCLUSIONThe elderly patients are prone to have pulmonary infection after the total hip arthroplasty,and the postoperative detection of the serum inflammatory factors in early stage may facilitate the diagnosis of pulmonary infection.
引文
[1]岳辰,谢锦伟,谭振,等.肥胖对全髋关节置换术后早期并发症影响的前瞻性研究[J].中国矫形外科杂志,2015,23(17):1537-1541.
[2]Eethakota VVS,Vaishnav V,Johnston L,et al.Comparison of revision risks and complication rates between total HIP replacement and HIP resurfacing within the similar age group[J].Surgeon,2018,16(6):339-349.
[3]吕科琼,杨利君,孙红华,等.高龄患者全髋关节置换术后预防肺部感染的干预措施分析[J].中华医院感染学杂志,2016,26(10):2317-2319.
[4]Hirsch J,Vacas S,Terrando N,et al.Perioperative cerebrospinal fluid and plasma inflammatory markers after orthopedic surgery[J].J Neuroinflammation,2016,13(1):211.
[5]Forget P,Rengger N,Berliere M,et al.Inflammatory scores are not interchangeable during the perioperative period of breast cancer surgery[J].Int J Surg,2014,12(12):1360-1362.
[6]Zhang Y,Jiang Q,Li T.Nalbuphine analgesic and anti-inflammatory effects on patients undergoing thoracoscopic lobectomy during the perioperative period[J].Exp Ther Med,2017,14(4):3117-3121.
[7]中华医学会呼吸病学分会.医院获得性肺炎诊断和治疗指南(草案)[J].现代实用医学,2002,14(3):160-161.
[8]叶应妩,王毓三.全国临床检验操作规程[M].3版.南京:东南大学出版社,1997:231-236.
[9]Newman ET,Watters TS,Lewis JS,et al.Impact of perioperative allogeneic and autologous blood transfusion on acute wound infection following total knee and total hip arthroplasty[J].J Bone Joint Surg Am,2014,96(4):279-284.
[10]梅晓亮,郭亭,赵建宁.全髋关节置换术后血清炎性因子表达特点及临床意义[J].中国骨伤,2011,24(6):463-465.
[11]何杰,刘杨,张旭.前外侧肌间隙入路术式微创全髋关节置换术对老年患者早期炎症反应影响[J].临床军医杂志,2017,45(8):813-815.
[12]Mjaaland KE,Kivle K,Svenningsen S,et al.Comparison of markers for muscle damage,inflammation,and pain using minimally invasive direct anterior versus direct lateral approach in total hip arthroplasty:aprospective,randomized,controlled trial[J].J Orthop Res,2015,33(9):1305-1310.
[13]王贵方,尚平福,王涛.老年全髋关节置换术后谵妄与围术期炎症因子水平的相关性研究[J].实用骨科杂志,2017,23(4):306-308.
[14]郁鹏,郭明珂,杨迪,等.血清炎症因子对闭合性骨折内固定术后感染预测的研究[J].中华创伤骨科杂志,2018,20(4):356-359.
[15]Stjarne Aspelund A,Hammarstrom H,Inghammar M,et al.Heparin-binding protein,lysozyme,and inflammatory cytokines in bronchoalveolar lavage fluid as diagnostic tools for pulmonary infection in lung transplanted patients[J].Am JTransplant,2018,18(2):444-452.
[16]Matar HE,Stritch P,Emms N.Infected total hip replacements:assessment and management[J].Br J Hosp Med,2018,79(5):265-269.
[17]Guthrie JW,Fitzpatrick N.Single-stage revision of an infected total hip replacement using antibiotic-impregnated bioabsorbable beads in a canine patient[J].VCOT Open,2019,2(1):e5-e12.
[18]孙相祥,马建兵,肖琳,等.人工全膝关节置换术中保留滑膜对术后感染的预防效果[J].安徽医药,2018,22(5):848-852.
[19]Molyneaux PL,Cox MJ,Willis-Owen SA,et al.The role of bacteria in the pathogenesis and progression of idiopathic pulmonary fibrosis[J].Am J Respir Crit Care Med,2014,190(8):906-913.
[20]Green BJ,Wiriyachaiporn S,Grainge C,et al.Potentially pathogenic airway bacteria and neutrophilic inflammation in treatment resistant severe asthma[J].PLoS One,2014,9(6):e100645.
[21]高海荣,张树新,郑霞,等.高血压脑出血患者术后肺部感染病原菌分布及外周血指标的诊断评价[J].中华医院感染学杂志,2017(17):3882-3885.
[22]Yakubek GA,Curtis GL,Sodhi N,et al.Chronic obstructive pulmonary disease is associated with short-term complications following total hip arthroplasty[J].J Arthroplasty,2018,33(6):1926-1929.
[23]Lasater KB,Mchugh MD.Nurse staffing and the work environment linked to readmissions among older adults following elective total hip and knee replacement[J].Int J Qual Health Care,2016,28(2):253-258.
[24]Elings J,Van der Sluis G,Goldbohm RA,et al.Development of a risk stratification model for delayed inpatient recovery of physical activities in patients undergoing total hip replacement[J].J Orthop Sports Phys Ther,2016,46(3):135-143.
[25]Kjaergaard N,Kjaersgaard JB,Petersen CL,et al.Thresholds for the Oxford Hip Score after total hip replacement surgery:a novel approach to postoperative evaluation[J].J Orthop Traumatol,2017,18(4):401-406.
[2]Eethakota VVS,Vaishnav V,Johnston L,et al.Comparison of revision risks and complication rates between total HIP replacement and HIP resurfacing within the similar age group[J].Surgeon,2018,16(6):339-349.
[3]吕科琼,杨利君,孙红华,等.高龄患者全髋关节置换术后预防肺部感染的干预措施分析[J].中华医院感染学杂志,2016,26(10):2317-2319.
[4]Hirsch J,Vacas S,Terrando N,et al.Perioperative cerebrospinal fluid and plasma inflammatory markers after orthopedic surgery[J].J Neuroinflammation,2016,13(1):211.
[5]Forget P,Rengger N,Berliere M,et al.Inflammatory scores are not interchangeable during the perioperative period of breast cancer surgery[J].Int J Surg,2014,12(12):1360-1362.
[6]Zhang Y,Jiang Q,Li T.Nalbuphine analgesic and anti-inflammatory effects on patients undergoing thoracoscopic lobectomy during the perioperative period[J].Exp Ther Med,2017,14(4):3117-3121.
[7]中华医学会呼吸病学分会.医院获得性肺炎诊断和治疗指南(草案)[J].现代实用医学,2002,14(3):160-161.
[8]叶应妩,王毓三.全国临床检验操作规程[M].3版.南京:东南大学出版社,1997:231-236.
[9]Newman ET,Watters TS,Lewis JS,et al.Impact of perioperative allogeneic and autologous blood transfusion on acute wound infection following total knee and total hip arthroplasty[J].J Bone Joint Surg Am,2014,96(4):279-284.
[10]梅晓亮,郭亭,赵建宁.全髋关节置换术后血清炎性因子表达特点及临床意义[J].中国骨伤,2011,24(6):463-465.
[11]何杰,刘杨,张旭.前外侧肌间隙入路术式微创全髋关节置换术对老年患者早期炎症反应影响[J].临床军医杂志,2017,45(8):813-815.
[12]Mjaaland KE,Kivle K,Svenningsen S,et al.Comparison of markers for muscle damage,inflammation,and pain using minimally invasive direct anterior versus direct lateral approach in total hip arthroplasty:aprospective,randomized,controlled trial[J].J Orthop Res,2015,33(9):1305-1310.
[13]王贵方,尚平福,王涛.老年全髋关节置换术后谵妄与围术期炎症因子水平的相关性研究[J].实用骨科杂志,2017,23(4):306-308.
[14]郁鹏,郭明珂,杨迪,等.血清炎症因子对闭合性骨折内固定术后感染预测的研究[J].中华创伤骨科杂志,2018,20(4):356-359.
[15]Stjarne Aspelund A,Hammarstrom H,Inghammar M,et al.Heparin-binding protein,lysozyme,and inflammatory cytokines in bronchoalveolar lavage fluid as diagnostic tools for pulmonary infection in lung transplanted patients[J].Am JTransplant,2018,18(2):444-452.
[16]Matar HE,Stritch P,Emms N.Infected total hip replacements:assessment and management[J].Br J Hosp Med,2018,79(5):265-269.
[17]Guthrie JW,Fitzpatrick N.Single-stage revision of an infected total hip replacement using antibiotic-impregnated bioabsorbable beads in a canine patient[J].VCOT Open,2019,2(1):e5-e12.
[18]孙相祥,马建兵,肖琳,等.人工全膝关节置换术中保留滑膜对术后感染的预防效果[J].安徽医药,2018,22(5):848-852.
[19]Molyneaux PL,Cox MJ,Willis-Owen SA,et al.The role of bacteria in the pathogenesis and progression of idiopathic pulmonary fibrosis[J].Am J Respir Crit Care Med,2014,190(8):906-913.
[20]Green BJ,Wiriyachaiporn S,Grainge C,et al.Potentially pathogenic airway bacteria and neutrophilic inflammation in treatment resistant severe asthma[J].PLoS One,2014,9(6):e100645.
[21]高海荣,张树新,郑霞,等.高血压脑出血患者术后肺部感染病原菌分布及外周血指标的诊断评价[J].中华医院感染学杂志,2017(17):3882-3885.
[22]Yakubek GA,Curtis GL,Sodhi N,et al.Chronic obstructive pulmonary disease is associated with short-term complications following total hip arthroplasty[J].J Arthroplasty,2018,33(6):1926-1929.
[23]Lasater KB,Mchugh MD.Nurse staffing and the work environment linked to readmissions among older adults following elective total hip and knee replacement[J].Int J Qual Health Care,2016,28(2):253-258.
[24]Elings J,Van der Sluis G,Goldbohm RA,et al.Development of a risk stratification model for delayed inpatient recovery of physical activities in patients undergoing total hip replacement[J].J Orthop Sports Phys Ther,2016,46(3):135-143.
[25]Kjaergaard N,Kjaersgaard JB,Petersen CL,et al.Thresholds for the Oxford Hip Score after total hip replacement surgery:a novel approach to postoperative evaluation[J].J Orthop Traumatol,2017,18(4):401-406.