我国全髋关节置换术后手术部位感染危险因素的Meta分析

发布时间：2018-06-24 04:06

  本文选题：全髋关节置换术 + 手术部位感染　； 参考：《遵义医学院》2017年硕士论文

【摘要】：目的:系统评价我国全髋关节置换术(total hip arthroplasty,THA)相关研究,分析手术部位感染高危因素,为制订手术部位感染(surgical site infection,SSI)控制策略提供依据。方法:检索Embase、Pubmed、Web of Science、Cochrane、CNKI、CBM、VIP和Wanfang8个数据库。纳入病例组为全髋关节置换术后发生SSI的患者,对照组为未发生SSI者,结局指标为SSI的相关因素,包含46个因素,归纳为社会人口学因素、原发性疾病、合并基础疾病、医源性因素、检验指标五大类。由两名研究者根据纳入排除标准独立筛选文献、提取资料和质量评价后,用Rev.Man5.2软件进行Meta分析。结果:纳入22篇研究,全髋关节置换术患者9073例,发生术后感染580例。Meta分析结果显示:(1)全髋关节置换术后手术部位感染发生率在以下组间差异均有统计学意义:平均年龄[SMD=0.85,95%CI(0.33,1.37)]、年龄≥60岁[OR=4.22,95%CI(3.17,5.61)]、糖尿病[OR=5.38,95%CI(2.78,10.39)]、合并其他基础疾病[OR=3.77,95%CI(2.69,5.29)]、平均手术时间[SMD=0.73,95%CI(0.55,0.91)]、手术时间≥180min[OR=2.81,95%CI(2.08,3.80)]、平均引流时间[SMD=0.67,95%CI(0.35,0.99)]、引流时间≥48h[OR=1.83,95%CI(1.31,2.56)]、长期使用激素[OR=9.27,95%CI(4.47,19.23)]、髋关节手术史[OR=4.18,95%CI(2.29,7.63)]、术中平均出血量[SMD=0.19,95%CI(0.01,0.37)]、术中出血量≥200ml[OR=1.99,95%CI(1.14,3.48)]、输血量≥800ml[OR=2.32,95%CI(1.39,3.85)]、抗生素使用种类≥2种[OR=3.92,95%CI(2.19,7.02)]、ASA评分III-IV级[OR=3.03,95%CI(1.51,6.08)]、住院时间≥14d[OR=15.62,95%CI(5.62,43.36)]、术前平均白蛋白[SMD=-5.37,95%CI(-6.39,-4.34)]、血清白蛋白35g/L[OR=4.79,95%CI(2.26,10.16)]、术前血红蛋白[SMD=-0.96,95%CI(-1.18,-0.75)]、血糖[SMD=1.02,95%CI(0.60,1.45)]。(2)在以下组间差异无统计学意义:性别[OR=0.99,95%CI(0.82,1.20)]、BMI[SMD=0.17,95%CI(-0.05,0.40)]、股骨头坏死和股骨颈骨折[OR=1.46,95%CI(0.71,2.99)]、髋关节骨性关节炎和股骨头坏死OR=1.12,95%CI(0.31,4.00)]、髋关节骨性关节炎和股骨颈骨折[OR=1.43,95%CI(0.33,6.24)]、类风湿关节炎[OR=2.62,95%CI(0.69,9.97)]、引流时间≥24h[OR=0.35,95%CI(0.01,10.43)]、假体类型[OR=1.06,95%CI(0.69,1.62)]、硬膜外麻醉和全麻[OR=1.08,95%CI(0.67,1.73)]、全麻和联合麻醉[OR=1.34,95%CI(0.79,2.26)]、抗生素使用时间[OR=1.17,95%CI(0.71,1.94)]、手术方式[OR=1.68,95%CI(0.76,3.72)]。结论:建议设定年龄超过60岁、住院时间超过14天、长期使用激素治疗、合并糖尿病、既往有髋关节手术史、血清白蛋白≤35g/L、ASA评分III-IV级、抗生素使用种类≥2种、手术时间≥180min、引流时间≥48h、术中出血量≥200ml为全髋关节置换术后发生SSI的预警指标。
[Abstract]:Objective: to systematically evaluate the related studies of (total hip arthroplasty (tha) in China, analyze the risk factors of infection in operation site, and provide the basis for formulating the control strategy of (surgical site infection in surgical site. Methods: eight databases of Embase Pubmedus Web of Science Cochraneus CNKICIM VIP and Wanfang were searched. The patients with SSI after total hip replacement were included in the study group, and those in the control group were those without SSI. The outcome index was related factors of SSI, including 46 factors, which were classified as social demographic factors, primary diseases, and combined with basic diseases. Iatrogenic factors, test indicators of five categories. According to the exclusion criteria, two researchers independently sifted the literature, extracted the data and evaluated the quality. The meta-analysis was carried out with the software Rev.Man5.2. Results: 9073 patients with total hip arthroplasty were included in 22 studies. Meta-analysis of 580 cases of postoperative infection: (1) the incidence of postoperative site infection after total hip arthroplasty was significantly different among the following groups: mean age [SMD-0.8595 CI (0.331.37)], age 鈮，

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