北京市全膝关节置换术手术部位感染监测的多中心研究

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摘要目的通过对北京地区2012年1月至2017年12月实施全膝关节置换术患者的信息进行分析，探讨该地区全膝关节置换术手术部位感染率及相关危险因素，为手术部位感染的防控提供依据。方法研究数据来源于北京医院感染监控管理系统，对80所二级及以上医疗机构全膝关节置换术患者开展前瞻性目标监测。本研究共监测全膝关节置换术患者11 148例，其中男2 225例，女8 923例；年龄>75岁患者1 667例，≤75岁患者9 481例。采用SPSS 20.0软件对手术部位感染情况进行统计分析，并对手术感染的危险因素行Logistic多因素回归分析。结果共发生手术部位感染28例，感染率为0.25%。多因素logistic回归分析显示，手术时间长、引流、医院级别低是全膝关节置换术手术部位感染发生的独立危险因素。手术持续时间>90 min的患者相较于≤90 min的患者，手术后感染的风险有所增加(OR=4.509，95%CI：1.349~15.070)；三级医院相比二级医院的手术患者，手术后感染的风险有所降低(OR=0.214，95%CI：0.099~0.461)；引流可增加手术部位感染的风险(OR=6.619，95%CI：1.948~22.487)。结论北京医院感染监控管理系统开展的全膝关节置换术手术部位感染目标性监测可作为其他机构监测工作的参考；手术部位感染的发生受多因素的影响，需要采取综合性的手术部位感染防控措施来降低感染风险，确保手术患者安全。

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	任燕 1
	刘爽 1
	杨琳 1
	武迎宏 2
	陈辉 1*

关键词 ：膝关节, 置换, 手术部位感染, 危险因素, 监测

Abstract：Objective To explore the surgical site infection rate and the risk factors by analysis data from targeted monitoring of surgical site infecitons after total knee arthroplasty in Beijing from 2012 to 2017.Methods The data contains information on patients undergoing total knee arthroplasty in 80 hospitals of secondary and tertiary hospitals in Beijing hospital infection monitoring management system.A total of 11 148 cases of total knee arthroplasty patients were monitored，including 2 225 males，8 923 females，1 667 patients aged>75 years and 9 481 patients aged≤75 years.SPSS 20.0 software was used to describe and analyze the infection of the surgical site by Logistic regression.Results 28 cases (0.25%) developed surgical site infection.Multivariate logistic regression analysis showed that long operation duration，drainage and low level of operation hospital were the risk factors of surgical site infection in total knee arthroplasty.The risk of surgical site infection was higher in patients with operation time more than 90minutes than in patients with operation time less than 90minutes (OR=4.509，95%CI：1.349~15.070).The risk of surgical site infection was lower (OR=0.214，95%CI：0.099~0.461) in tertiary hospitals than in secondary hospitals.Drainage could increase the risk of surgical site infection (OR=6.619，95%CI：1.948~22.487).Conclusion The targeted monitoring method of surgical site infection of total knee arthroplasty in the Beijing Hospital infection monitoring management system can be used as a reference for other institutions to carry out monitoring work.The occurrence of surgical site infection is affected by many factors，so comprehensive prevention and control measures should be taken to reduce the risk of infection and ensure the safety of patients.

Key words： Knee joint Replacement Surgical site infection Risk factors Monitoring

基金资助:北京市属医院科研培育项目(PG2021007)
首都卫生发展科研专项(2021-1G-2071)

通讯作者: 陈辉

作者简介: 任燕(1981－ )，女，副主任医师，北京积水潭医院院感处，ryjst@126.com。

引用本文:

任燕 1，刘爽 1，杨琳 1，武迎宏 2，陈辉 1*. 北京市全膝关节置换术手术部位感染监测的多中心研究[J]. 实用骨科杂志, 2022, 28(3): 215-219.
Ren Yan 1，Liu Shuang 1，Yang Lin 1，Wu Yinghong 2，Chen Hui 1. A Multicenter Study on Surveillance of Surgical Site Infection After Total Knee Arthroplasty in Beijing. sygkzz, 2022, 28(3): 215-219.

链接本文:

http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2022/V28/I3/215

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