某医院全髋关节置换术后患者院内感染相关因素的回顾性分析
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摘要
目的探讨某医院全髋关节置换术后患者院内感染相关因素。方法选取2013年7月-2015年10月期间在本院行全髋关节置换术的172例患者进行回顾性分析,根据患者院内感染情况,将其分为院内感染组和无院内感染组。采用Logistic回归分析模型分析影响全髋关节置换术后患者院内感染的危险因素。结果 172例全髋关节置换术后患者中,院内感染19例(11.05%),无院内感染153例(88.95%);感染部位:呼吸道9例(47.37%),泌尿系9例(47.37%),皮肤(褥疮)1例(5.26%);发生时间为术后1~13 d。单因素分析结果显示:院内感染组的手术时间、血红蛋白、白蛋白、输血量、尿管留置时间、抗生素使用时间与无院内感染组比较存在明显差异(P<0.05);Logistic回归模型分析结果显示:白蛋白≤35 g/L、血红蛋白≤110 g/L、手术时间>180 min、尿管留置时间>45 h、动脉压>105 mm Hg、血肌酐>133μmol/L、血浆白蛋白<35 g/L、抗生素使用时间<5 d是影响全髋关节置换术后患者院内感染的独立危险因素(P<0.001)。结论全髋关节置换术后患者院内感染发生率较高,手术时间、血红蛋白、白蛋白、尿管留置时间、抗生素使用时间是影响全髋关节置换术后患者院内感染的独立危险因素,有效缩短手术、尿管留置时间,延长抗生素治疗时间,积极进行升血红蛋白、白蛋白治疗可降低全髋关节置换术后患者院内感染的发生率。
Objective To investigate the related factors of nosocomial infections in patients after total hip arthroplasty in a hospital. Methods A retrospective analysis of 172 patients undergoing total hip arthroplasty in our hospital between July 2013 and October 2015 was performed. These patients were divided into the nosocomial infection group and the non-nosocomial infection group. A logistic regression model was used to analyze the risk factors for nosocomial infections in patients after total hip arthroplasty.Results Of the 172 total hip arthroplasty patients,19 had nosocomial infections( 11.05%) and 153 had no nosocomial infections( 88.95%). The infected parts were the respiratory tract in 9 cases( 47.37%),urinary tract in 9 cases( 47.37%),and skin( bedsore) in 1 case( 5.26%). Infections occurred 1 to 13 days after surgery. Univariate analysis showed that the duration of surgery,hemoglobin,albumin,blood transfusion,catheter indwelling time,and length of antibiotic use in the nosocomial infection group were significantly different from those in the non-nosocomial infection group( P < 0. 05). Logistic regression analysis showed that serum albumin ≤150 g/L,hemoglobin ≤110 g/L,duration of surgery> 180 min,catheter indwelling time> 45 h,arterial pressure >105 mm Hg,serum creatinine >133 μmol/Plasma albumin <35 g/L and length of antibiotic use <5 d were all independent risk factors for nosocomial infections after total hip arthroplasty( P<0.001).Conclusion After total hip arthroplasty,patients have a higher incidence of nosocomial infections. The duration of surgery,hemoglobin,albumin,catheter indwelling time,length of antibiotic use are all independent risk factors for nosocomial infections in patients after total hip arthroplasty. Effectively shortening the duration of surgery and catheter indwelling,prolonging the time of antibiotic treatment,active treatment of hemologlobin and albumin can reduce the incidence of nosocomial infections in patients after total hip arthroplasty.
Objective To investigate the related factors of nosocomial infections in patients after total hip arthroplasty in a hospital. Methods A retrospective analysis of 172 patients undergoing total hip arthroplasty in our hospital between July 2013 and October 2015 was performed. These patients were divided into the nosocomial infection group and the non-nosocomial infection group. A logistic regression model was used to analyze the risk factors for nosocomial infections in patients after total hip arthroplasty.Results Of the 172 total hip arthroplasty patients,19 had nosocomial infections( 11.05%) and 153 had no nosocomial infections( 88.95%). The infected parts were the respiratory tract in 9 cases( 47.37%),urinary tract in 9 cases( 47.37%),and skin( bedsore) in 1 case( 5.26%). Infections occurred 1 to 13 days after surgery. Univariate analysis showed that the duration of surgery,hemoglobin,albumin,blood transfusion,catheter indwelling time,and length of antibiotic use in the nosocomial infection group were significantly different from those in the non-nosocomial infection group( P < 0. 05). Logistic regression analysis showed that serum albumin ≤150 g/L,hemoglobin ≤110 g/L,duration of surgery> 180 min,catheter indwelling time> 45 h,arterial pressure >105 mm Hg,serum creatinine >133 μmol/Plasma albumin <35 g/L and length of antibiotic use <5 d were all independent risk factors for nosocomial infections after total hip arthroplasty( P<0.001).Conclusion After total hip arthroplasty,patients have a higher incidence of nosocomial infections. The duration of surgery,hemoglobin,albumin,catheter indwelling time,length of antibiotic use are all independent risk factors for nosocomial infections in patients after total hip arthroplasty. Effectively shortening the duration of surgery and catheter indwelling,prolonging the time of antibiotic treatment,active treatment of hemologlobin and albumin can reduce the incidence of nosocomial infections in patients after total hip arthroplasty.
引文
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[12]陵廷贤,李金龙,周凯,等.髋、膝关节置换围术期尿路感染临床分析[J].实用骨科杂志,2017,23(6):559.
[13]李永新,尹利荣,李燕莉,等.人工全髋关节置换术后下肢深静脉血栓形成的高危因素[J].中国临床保健杂志,2017,20(3):282.
[14]李静,张宁,邵宏翊,等.60例人工关节置换术后假体周围感染患者病原学回顾性分析[J].临床药物治疗杂志,2017,15(6):44.
[15]刘军,张陆,高松明,等.全髋关节置换患者假体周围感染分析与预防研究[J].中华医院感染学杂志,2016,26(13):3040.
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[18]张东霞,李国红,侯照银,等.人工髋关节置换术后患者感染病原菌分析[J].中华医院感染学杂志,2016,26(6):1356.
[19]陈小红,翁晓华,王葵儿.全髋关节置换术后患者感染的影响因素分析[J].中华医院感染学杂志,2016,26(1):131.
[20]纪保超,徐恩洁,曹力,等.人工髋膝关节置换术后假体周围慢性感染病原菌培养方法及结果分析[J].中华外科杂志,2015,53(2):130.
[2]戴书静,刘佳.不同镇痛方式对全髋关节置换患者细胞因子及皮质醇水平的影响[J].解放军预防医学杂志,2015,33(4):421.
[3]闫莉,王荣国,崔健,等.老年股骨颈骨折患者行全髋关节置换术后麻醉恢复期躁动的影响因素[J].现代生物医学进展,2016,16(28):5536.
[4]刘明东,周祖彬,刘国太,等.全髋关节置换术后切口感染的危险因素与病原学分析[J].中华医院感染学杂志,2017,27(12):2767.
[5]田华,王金波.输血对关节置换老年患者认知能力的影响[J].解放军预防医学杂志,2016,34(1):71.
[6]钟伟洋,梁欣洁,权正学,等.回顾性分析临床路径在全髋关节置换术患者围手术期的应用效果[J].中国病案,2016,17(9):33.
[7]王晓婷.人工髋关节置换术优质护理分析[J].保健医学研究与实践,2015,12(1):75.
[8]张杰,陈平,荣冬明,等.人工关节置换术后并发深静脉血栓形成的危险因素评估[J].中国矫形外科杂志,2016,24(11):1001.
[9]刘刚,袁东堂,于广洋,等.髋关节置换术后中位生存时间及相关预后影响因素分析[J].实用骨科杂志,2016,22(1):28.
[10]蒲川成,冉学军,覃勇志,等.人工髋关节置换术后慢性感染的危险因素分析[J].实用骨科杂志,2017,23(7):6402.
[11]刘守应,蔡胥,王继芳.二期翻修治疗髋关节置换术后感染临床分析[J].中华保健医学杂志,2015,17(2):126.
[12]陵廷贤,李金龙,周凯,等.髋、膝关节置换围术期尿路感染临床分析[J].实用骨科杂志,2017,23(6):559.
[13]李永新,尹利荣,李燕莉,等.人工全髋关节置换术后下肢深静脉血栓形成的高危因素[J].中国临床保健杂志,2017,20(3):282.
[14]李静,张宁,邵宏翊,等.60例人工关节置换术后假体周围感染患者病原学回顾性分析[J].临床药物治疗杂志,2017,15(6):44.
[15]刘军,张陆,高松明,等.全髋关节置换患者假体周围感染分析与预防研究[J].中华医院感染学杂志,2016,26(13):3040.
[16]吕增亮,葛武.髋膝关节置换术后假体周围感染的危险因素分析[J].中国临床研究,2015,28(11):1496.
[17]马志翔,尹宗生,许鹏飞,等.合肥地区人工髋关节置换病因及相关因素:6年5所医院3056例回顾性分析[J].中国组织工程研究,2015,19(9):1352.
[18]张东霞,李国红,侯照银,等.人工髋关节置换术后患者感染病原菌分析[J].中华医院感染学杂志,2016,26(6):1356.
[19]陈小红,翁晓华,王葵儿.全髋关节置换术后患者感染的影响因素分析[J].中华医院感染学杂志,2016,26(1):131.
[20]纪保超,徐恩洁,曹力,等.人工髋膝关节置换术后假体周围慢性感染病原菌培养方法及结果分析[J].中华外科杂志,2015,53(2):130.