糖尿病患者骨关节置换术围手术期血糖控制水平对手术部位感染及病原菌分布的影响  

Influence of peri-operative blood glucose control level on surgical site infection and pathogen distribution in patients with diabetes undergoing bone and joint replacement

作　　者：何红英 王琼 宋江润 吕泽斌 杨新丽 吴芸 马宏娟 韩丽 HE Hong-ying;WANG Qiong;SONG Jiang-run;LYU Ze-bin;YANG Xin-li;WU Yun;MA Hong-juan;HAN Li(Department of Orthopedics,Affiliated Hospital of Gansu Medical College,Pingliang 744000,China;Wound Diagnosis and Treatment Center,Affiliated Hospital of Gansu Medical College,Pingliang 744000,China;Department of Academic Affairs,Gansu Medical College,Pingliang 744000,China)

机构地区：[1]甘肃医学院附属医院骨科,甘肃平凉744000 [2]甘肃医学院附属医院伤口诊疗中心,甘肃平凉744000 [3]甘肃医学院教务处,甘肃平凉744000

出　　处：《中国感染控制杂志》2023年第2期167-174,共8页Chinese Journal of Infection Control

基　　金：甘肃省高等学校创新基金项目(2023B-269);平凉市科技计划项目(2022B-013)。

摘　　要：目的探讨糖尿病患者骨关节置换术围手术期血糖控制水平对手术部位感染及病原菌分布的影响。方法选择2014年5月—2022年5月在7所医院择期行骨关节置换并2型糖尿病的患者为研究对象。根据围手术期转化血红蛋白(HbAlc)水平将患者分为血糖控制良好组与血糖控制不佳组,比较两组手术部位感染率、切口愈合时间、住院时间、医疗总费用、感染病原菌分布及耐药性。应用单因素及多因素分析血糖控制不佳的危险因素。结果共纳入1480例患者,血糖控制良好组768例,血糖控制不佳组712例。血糖控制良好组与血糖控制不佳组的手术部位感染率分别为7.16%、14.89%,血糖控制良好组切口愈合时间、住院时间、感染病程和医疗总费用均小于血糖控制不佳组(均P<0.01);血糖控制良好组革兰阳性(G+)菌检出构成比高于血糖控制不佳组,而革兰阴性(G-)菌检出构成比低于血糖控制不佳组(P<0.05);糖尿病病程>10年[OR=1.826,95%CI(1.664~2.005)]、术前HAMA>14分[OR=3.301,95%CI(1.756~6.215)]、全身麻醉[OR=1.941,95%CI(1.057~3.563)]和手术时间>3 h[OR=2.308,95%CI(1.134~4.657)]是骨关节置换围手术期血糖控制不佳的独立危险因素(均P<0.05)。结论糖尿病患者骨关节置换围手术期血糖控制情况对手术部位感染及病原菌分布均有一定影响,患者术前焦虑状态、糖尿病病程、麻醉方式及手术持续时间是围手术期血糖控制不佳的独立危险因素。Objective To investigate the effect of peri-operative blood glucose control level on surgical site infection(SSI)and pathogen distribution in patients with diabetes undergoing bone and joint replacement.Methods From May 2014 to May 2022,patients with type 2 diabetes undergoing bone and joint replacement in 7 hospitals were selected as studied subjects.According to peri-operative level of hemoglobin A1c(HbAlc),patients were divided into good blood glucose control(GBGC)group and poor blood glucose control(PBGC)group.Incidence of SSI,wound healing time,length of hospital stay,total medical expense,distribution of infection pathogens and antimicrobial resistance were compared between two groups.Univariate and multivariate analyses were used to analyze the risk factors for PBGC.Results A total of 1480 patients were recruited,including 768 in GBGC group and 712 in PBGC group.Incidence of SSI were 7.16%and 14.89%in GBGC group and PBGC group respectively.Wound healing time,length of hospital stay,infection course and total medical expense in GBGC group were all lower than PBGC group(all P<0.01).Constituent rate of isolated Gram-positive(G+)bacteria in GBGC group was higher than that in PBGC group,while constituent rate of isolated Gram-negative(G-)bacteria in GBGC group was lower than that in PBGC group(P<0.05).The course of diabetes>10 years(OR=1.826,95%CI[1.664-2.005]),pre-operative Hamilton Anxiety Scale(HAMA)>14 points(OR=3.301,95%CI[1.756-6.215]),general anesthesia(OR=1.941,95%CI[1.057-3.563]),and duration of operation>3 hours(OR=2.308,95%CI[1.134-4.657])were independent risk factors for PBGC during peri-operative period of bone and joint replacement(all P<0.05).Conclusion The peri-operative blood glucose control of diabetes patients with bone and joint replacement has certain impact on SSI and pathogen distribution.Pre-operative anxiety state of patients,course of diabetes,mode of anesthesia and duration of surgery are independent risk factors for poor peri-operative blood glucose control.

关 键 词：手术部位感染 骨关节置换 糖尿病 围手术期血糖控制 病原菌分布 危险因素 

分 类 号：R619[医药卫生—外科学]