围手术期强化血糖控制对关节置换术后切口并发症的影响研究  

The Effect of Intensive Glucose Control on Postoperative Wound Complications in Total Joint Arthroplsty

作　　者：杨明新 谭美云[2] 

机构地区：[1]长宁县人民医院,四川长宁644300 [2]泸州医学院附属医院

出　　处：《中外医学研究》2015年第22期9-11,共3页CHINESE AND FOREIGN MEDICAL RESEARCH

摘　　要：目的：探究关节置换术围手术期最佳血糖控制水平和强化血糖控制对术后切口相关并发症的影响。方法：回顾2010-2014年行择期初次全髋关节置换术或全膝关节置换术的患者,根据术前血糖控制水平分为普通血糖控制组（空腹血糖水平7.8-10.0 mmol/L）与强化血糖控制组（空腹血糖水平4.4-7.8 mmol/L）,随访观察伤口渗液、切口部位感染、假体周围感染、低血糖、高血糖及心脑血管事件发生情况。结果：230例患者初次关节置换术患者纳入研究,其中糖尿病患者165例（71.7%）;强化血糖控制组2例（1.7%）患者发生手术部位感染率,普通血糖控制组8例（7.3%）,差异有统计学意义（P=0.021）,假体周围感染发生率无明显差异;强化血糖控制组有较少的伤口渗液发生率（7.5%vs 16.4%,P=0.037）;强化血糖控制还可减少平均住院日（P=0.018）;强化血糖控制组低血糖发生率较高（3.3%vs 1.8%）,差异无统计学意义（P=0.471）。结论：初次关节置换术围手术期强化血糖控制可有效降低术后早期切口并发症的发生率,但仍需改进方法避免低血糖的发生。Objective： To investigate the best perioperative glucose level in total joint arthroplasty and the effect of intensive glucose control on postoperative wound complications.Method： A retrospective study was conducted in patients undergoing primary total hip/knee arthroplsty from 2010 to 2014.They were assigned to either intensive glucose control with a blood glucose range of 4.4-7.8 mmol/L, or intermediate glucose control with a blood glucose range of 7.8- 10.0 mmol/L.We defined primary end point as the incidence of surgical site infection or periprosthetic joint infection.Result： The number of patients undergoing total joint arthrolasty was 230 cases, 165 cases（71.7%） were diabetes mellitus.Perioperatve intensive glucose control produced a significant reduction for the incidence of surgical site infection（1.7% vs 7.3%, P=0.021） and wound leakage（7.5% vs 16.4%, P=0.037）.A shorter hospital stay was seen in intensive glucose control group（P=0.018）.But intensive glucose control leaded a higher incidence of hypoglycemia（P=0.471）.Conclusion： Intensive glucose control could reduce the incidence of postoperative wound complications in total joint arthroplasty, but attention should be paid to the incidence of hypoglycemia.

关 键 词：关节置换术 强化血糖控制 手术切口感染 假体周围感染 

分 类 号：R687.4[医药卫生—骨科学]