膝关节置换术后发热相关因素分析.docVIP

膝关节置换术后发热相关因素分析 　 作者：宋炎成，蔡道章，王昆，沈彬，杨静，裴福兴 【摘要】 ［目的］分析引起膝关节置换术后发热的相关因素，旨在探讨术后发热与感染等因素的相关性。［方法］回顾性分析1998年8月～2006年4月间本院及华西医院骨科记录完整已行膝关节置换术的200例患者的体温表和病历。列表记录每例患者术前的平均最高体温和手术后7 d每天的最高体温，同时记录术前和术后第2 d的血色素值以及是否输血、使用导尿管、麻醉方式和基础疾病等。采用SPSS 12.0软件包进行统计分析。［结果］膝关节置换术前和术后7 d的患者体温有显著性统计学差异（P＜0.01），78例（39.0%）患者的体温≥38 ℃。16例患者发展为感染，浅层感染15例，经换药和抗生素治疗治愈，1例深部感染行假体取出，最终关节融合，但其中仅有3例患者的体温增高。术后发热与感染、输血、血色素下降、是否使用导尿管、麻醉方式以及术前发热之间没有明显的相关性（P＞0.05)。［结论］膝关节置换术后1周内发热属正常生理反应，与感染等因素无显著相关性。 【关键词】 置换； 发热； 感染； 相关因素 Abstract：［Objective］To determine the incidence and factors associated with pyrexia after total knee replacement(TKR).［Method］A retrospective review of 200 patients in departments of orthopaedics of our hospital and West China hospital who underwent TKRs from August 1998 and April 2006 was performed.The clinical,surgical and follow-up data were abstracted from the patients’ records and were analyzed with SPSS 12.0.［Result］There was a statistically significant increase of the mean temperature post-operations,which remained significant throughout the first 7 days after surgeries(P＜0.01),78(39.0%)patients were pyrexial(≥38 ℃）and 16 patients developed a clinical infection,but four of thom were pyrexial.There was no statistical association between pyrexia and infection,allogenic blood transfusion,decrease of haemoglobin,use of urinary catheter,rheumatoid arthritis,aesthetic type,and pyrexia before TKRs.［Conclusion］Pyrexia in the first 7 days following TKR is usually a normal physiological response and should not cause undue concern about the presence of infection.Pyrexia within the frist 7 days after TKR could be regarded as a physiological phenomenon and have no statistical significance with infection. Key words：knee joint; replacement; pyrexia; infection; correlation factor 膝关节置换术后最初几天发热的现象已经得到普遍共识，但对其原因却见解各异〔1、2〕。由于担心感染带来的灾难性后果，术后发热已经成为医务人员和患者共同关注的焦点。于是多种昂贵和无实际意义的检查用作辨别术后发热的原因，以及经验性的延长抗生素治疗的时间，进而使患者住院的时间延长，费用增加。本文回顾性分析1998年8月～2006年4月本院及华西医院骨科记录完整已行膝关节置换术的200例患者的体温表和病历，通过分析影响膝关节置换术后发热的相关因素