本文選題：全髖關節(jié)置換術 + 手術部位感染��； 參考：《遵義醫(yī)學院》2017年碩士論文

【摘要】：目的:系統(tǒng)評價我國全髖關節(jié)置換術(total hip arthroplasty,THA)相關研究,分析手術部位感染高危因素,為制訂手術部位感染(surgical site infection,SSI)控制策略提供依據(jù)。方法:檢索Embase、Pubmed、Web of Science、Cochrane、CNKI、CBM、VIP和Wanfang8個數(shù)據(jù)庫。納入病例組為全髖關節(jié)置換術后發(fā)生SSI的患者,對照組為未發(fā)生SSI者,結局指標為SSI的相關因素,包含46個因素,歸納為社會人口學因素、原發(fā)性疾病、合并基礎疾病、醫(yī)源性因素、檢驗指標五大類。由兩名研究者根據(jù)納入排除標準獨立篩選文獻、提取資料和質(zhì)量評價后,用Rev.Man5.2軟件進行Meta分析。結果:納入22篇研究,全髖關節(jié)置換術患者9073例,發(fā)生術后感染580例。Meta分析結果顯示:(1)全髖關節(jié)置換術后手術部位感染發(fā)生率在以下組間差異均有統(tǒng)計學意義:平均年齡[SMD=0.85,95%CI(0.33,1.37)]、年齡≥60歲[OR=4.22,95%CI(3.17,5.61)]、糖尿病[OR=5.38,95%CI(2.78,10.39)]、合并其他基礎疾病[OR=3.77,95%CI(2.69,5.29)]、平均手術時間[SMD=0.73,95%CI(0.55,0.91)]、手術時間≥180min[OR=2.81,95%CI(2.08,3.80)]、平均引流時間[SMD=0.67,95%CI(0.35,0.99)]、引流時間≥48h[OR=1.83,95%CI(1.31,2.56)]、長期使用激素[OR=9.27,95%CI(4.47,19.23)]、髖關節(jié)手術史[OR=4.18,95%CI(2.29,7.63)]、術中平均出血量[SMD=0.19,95%CI(0.01,0.37)]、術中出血量≥200ml[OR=1.99,95%CI(1.14,3.48)]、輸血量≥800ml[OR=2.32,95%CI(1.39,3.85)]、抗生素使用種類≥2種[OR=3.92,95%CI(2.19,7.02)]、ASA評分III-IV級[OR=3.03,95%CI(1.51,6.08)]、住院時間≥14d[OR=15.62,95%CI(5.62,43.36)]、術前平均白蛋白[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)]、術前血紅蛋白[SMD=-0.96,95%CI(-1.18,-0.75)]、血糖[SMD=1.02,95%CI(0.60,1.45)]。(2)在以下組間差異無統(tǒng)計學意義:性別[OR=0.99,95%CI(0.82,1.20)]、BMI[SMD=0.17,95%CI(-0.05,0.40)]、股骨頭壞死和股骨頸骨折[OR=1.46,95%CI(0.71,2.99)]、髖關節(jié)骨性關節(jié)炎和股骨頭壞死OR=1.12,95%CI(0.31,4.00)]、髖關節(jié)骨性關節(jié)炎和股骨頸骨折[OR=1.43,95%CI(0.33,6.24)]、類風濕關節(jié)炎[OR=2.62,95%CI(0.69,9.97)]、引流時間≥24h[OR=0.35,95%CI(0.01,10.43)]、假體類型[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)]、全麻和聯(lián)合麻醉[OR=1.34,95%CI(0.79,2.26)]、抗生素使用時間[OR=1.17,95%CI(0.71,1.94)]、手術方式[OR=1.68,95%CI(0.76,3.72)]。結論:建議設定年齡超過60歲、住院時間超過14天、長期使用激素治療、合并糖尿病、既往有髖關節(jié)手術史、血清白蛋白≤35g/L、ASA評分III-IV級、抗生素使用種類≥2種、手術時間≥180min、引流時間≥48h、術中出血量≥200ml為全髖關節(jié)置換術后發(fā)生SSI的預警指標。
[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，

本文編號：2059938