关节置换老年患者术后切口感染的危险因素及病原菌分布临床研究  

Risk Factors and Pathogen Analysis for Postoperative Incision Infection in Older Patients Undergoing Joint Replacement

作　　者：张苏玲[1] 史婷婷 刘颖 陈星 孔祥如[1] 刘旭 王冰[1] Zhang Suling;Shi Tingting;Liu Ying;Chen Xing;Kong Xiangru;Liu Xu;Wang Bing(Department of Orthopaedics,Suqian Peoples Hospital,Nanjing Drum-tower Hospital Group,Suqian 223800)

机构地区：[1]南京鼓楼医院集团宿迁市人民医院骨科,宿迁223800

出　　处：《国际老年医学杂志》2021年第6期339-341,380,共4页International Journal of Geriatrics

基　　金：江苏省重点研发专项基金(BE2019703)。

摘　　要：目的探讨老年关节置换患者术后切口感染的病原学分布特点和危险因素。方法选取南京鼓楼医院集团宿迁市人民医院骨科进行髋关节和膝关节置换的老年患者351例,统计患者手术后切口感染的发生情况和病原学分布状况,对导致患者发生切口感染的影响因素进行统计学分析。结果手术后有28例(7.98%)发生切口感染,感染患者切口分泌物中共培养出致病菌41株,其中,革兰阳性菌23株(56.10%),革兰阴性菌18株(43.90%)。多因素logistic回归分析提示,年龄≥75岁、体质指数≥25kg/m^(2)、合并糖尿病、贫血以及术中出血量≥800 ml是导致骨科老年关节置换患者术后切口感染发生的危险因素(P<0.05),而血清白蛋白≥35 g/L是保护因素(P<0.05)。结论骨科进行髋关节和膝关节置换的老年患者的切口感染率较高,主要致病菌为革兰阳性菌及革兰阴性菌,其与多种因素有关,应加以注意。Objective To investigate the risk factors and pathogen characteristics for the incision infection in older patients undergoing orthopaedic joint replacement.Methods 351 older patients who underwent hip and knee arthroplasty were selected in Suqian People’s Hospital of Nanjing Drum-tower Hospital Group.The incidence of postoperative incision infection and pathogenic characteristics were investigated.The influential factors of incision infection were analyzed.Results There were 28 cases(7.98%)with incision infection after operation.41 strains of pathogenic bacteria were found in the incision secretion from patients with incision infection,of which 23 strains(56.10%)were Gram-positive bacteria,and 18 strains(43.90%)were Gram-negative bacteria.Multivariate logistic regression analysis showed that the age(≥75 years old),body mass index(≥25 kg/m^(2)),diabetes mellitus,anemia and intraoperative bleeding(≥800 ml)were the risk factors for incision infection after orthopaedic joint replacement in older patients(P<0.05).The serum albumin(≥35 g/L)was the protective factor for avoiding infection(P<0.05).Conclusion The incidence of incision infection is high in older patients undergoing hip and knee joint replacement.The main pathogenic bacteria are Gram-positive bacteria and Gram-negative bacteria,which are related to many factors.

关 键 词：老年患者 关节置换 切口感染 致病菌 危险因素 

分 类 号：R687.4[医药卫生—骨科学]