2型糖尿病对骨关节手术后手术部位感染及预后影响的Meta分析  

Influence of Type 2 Diabetes on Operative Site Infection and Prognosis after Bone and Joint Surgery:A Meta-Analysis

作　　者：努尔比艳·克尤木[1] 石伟 曹浩然 马海平[1] NUERBIYAN·Keyoumu;SHI Wei;CAO Hao-ran;MA Hai-ping(Department of An-esthesiology,The First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,Xinjiang,China;不详)

机构地区：[1]新疆医科大学第一附属医院麻醉科,新疆乌鲁木齐830054 [2]昌吉州人民医院导管室,新疆昌吉830011

出　　处：《中国现代手术学杂志》2022年第4期248-254,共7页Chinese Journal of Modern Operative Surgery

基　　金：新疆维吾尔自治区重点实验室开放课题(2021D04021)。

摘　　要：目的系统分析2型糖尿病对骨关节手术后手术部位感染和预后的影响,为临床提供循证医学证据。方法计算机系统检索PubMed、EMbase、Cochrane图书馆、中国知网(CNKI)、中国生物医学网(CBM)、万方数据库(WanFang Data)2000年1月至2022年3月收录的关于2型糖尿病对骨关节手术后手术部位感染和预后影响的临床研究文献,采用纽卡斯尔-渥太华量表(Newcastle-Ottawa scale,NOS)评价文献质量,用RevMan 5.4软件按系统评价方法对提取的有效数据进行Meta分析。结果共纳入12篇文献(研究),总计1215905例患者,其中糖尿病患者142845例(11.75%)。Meta分析显示:糖尿病组患者术后手术部位感染率显著高于非糖尿病组(OR=1.66,95%CI:1.22~2.27,I^(2)=87%,P=0.001),心血管事件发生率亦明显高于非糖尿病组(OR=1.68,95%CI:1.31~2.14,I^(2)=84%,P<0.0001);两组术后30 d死亡率及深静脉血栓发生率比较均无统计学差异(OR=0.94,95%CI:0.85~1.04,I^(2)=40%,P=0.26;OR=0.82,95%CI:0.54~1.23,I^(2)=90%,P=0.34)。结论2型糖尿病患者骨关节手术后手术部位感染和心血管事件发生风险均显著增加,对该类患者行骨关节手术应认真做好风险评估和控制,尽力改善其预后和转归。Objective To systematically analyze the influence of type 2 diabetes on the surgical site infection and prognosis after bone and joint surgery,and to provide evidence-based medicine for clinical practice.Methods The data of clinical research literature of the influence of type 2 diabetes on the operative site infection and prognosis after bone and joint surgery from January 2000 to March 2022 were retrieved in the databases of PubMed,EMbase,Cochrane,CNKI,CBM and WanFang Data,and Newcastle-Ottawa scale(NOS)was used to evaluate the quality of the literature,and meta analysis was performed to assess the extracted data by systematic evaluation method with RevMan 5.4 software.Results A total of 1215905 cases were enrolled in 12 studies(literature)with 142845 diabetes cases(11.75%).Meta-analysis showed that both post-operative incidence of surgical site infection and cardiovascular events were higher significantly in the diabetic cases than those in the non-diabetic cases(OR:1.66,95%CI:1.22~2.27,I^(2)=87%,P=0.001;OR=1.68,95%CI:1.31~2.14,I^(2)=84%,P<0.0001).There was no remarkable difference in short-term mortality and incidence of deep vein thrombosis between the diabetic cases and non-diabetic cases(OR=0.94,95%CI:0.85~1.04,I^(2)=40%,P=0.26;OR=0.82,95%CI:0.54~1.23,I^(2)=90%,P=0.34).Conclusions The risk of surgical site infection and cardiovascular events would increase significantly in the patients with type 2 diabetes after bone and joint surgery.Careful and appropriate surgical risk assessment and control is necessary for them to improve the prognosis and outcome.

关 键 词：糖尿病 2型 骨关节手术 切口感染 预后 不良心血管事件 深静脉血栓形成 META分析 

分 类 号：R687[医药卫生—骨科学] R587.1[医药卫生—外科学]