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中华实验和临床感染病杂志(电子版)

中华实验和临床感染病杂志(电子版) ›› 2020, Vol. 14 ›› Issue (02) : 123 -127. doi: 10.3877/cma.j.issn.1674-1358.2020.02.007

所属专题： 文献；

论著

肩关节镜术后糖皮质激素注射时间和剂量与术后感染的相关性
卢镇生1,†(), 叶握球1, 杨挺1, 黄旭丽1   
  1. 1. 515300　普宁市，广东省普宁市人民医院骨外科
  • 收稿日期:2019-07-17 出版日期:2020-04-15
  • 通信作者: 卢镇生
  • 基金资助:
    2017年度广东省医学科研基金立项课题(No. B2017018)

Correlation between the period and dose of glucocorticoid injection and postoperative infection after shoulder arthroscopy

Zhensheng Lu1,†(), Shouqiu Ye1, Ting Yang1, Xuli Huang1   

  1. 1. Orthopedics Department of Puning People’s Hospital, 515300 Puning, China
  • Received:2019-07-17 Published:2020-04-15
  • Corresponding author: Zhensheng Lu
  • About author:
    Corresponding author: Lu Zhensheng, Email:
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卢镇生, 叶握球, 杨挺, 黄旭丽. 肩关节镜术后糖皮质激素注射时间和剂量与术后感染的相关性[J/OL]. 中华实验和临床感染病杂志(电子版), 2020, 14(02): 123-127.

Zhensheng Lu, Shouqiu Ye, Ting Yang, Xuli Huang. Correlation between the period and dose of glucocorticoid injection and postoperative infection after shoulder arthroscopy[J/OL]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2020, 14(02): 123-127.

目的

探讨肩关节镜术后糖皮质激素注射时间与剂量对术后感染的影响，为防治肩关节镜术后并发症提供新思路。

方法

选取2014年2月至2018年3月普宁市人民医院收治的行肩关节镜手术94例患者为研究对象，根据术后是否发生感染将患者分为感染组（21例）和未感染组（73例）。分析两组术后感染发病率和病原菌分布。探讨患者的年龄、性别、住院时间、手术时间、糖皮质激素使用等与术后感染发生率的相关性。通过ROC曲线预测糖皮质激素注射时间与剂量对肩关节镜术后感染的影响。

结果

肩关节镜术后感染者共21例，感染率为22.3%，其中革兰阴性菌8株（38.0%），革兰阳性菌12株（57.2%），真菌1株（4.8%）。与未感染组相比，感染组患者年龄、住院时间、手术时间、合并糖尿病、抗菌药物使用时间、糖皮质激素治疗日均剂量和使用时间差异均有统计学意义（P均< 0.05）；多因素Logistic回归分析显示，手术时间（OR = 1.238、P = 0.026）、糖皮质激素治疗日均剂量（OR = 1.485、P = 0.019）和使用时间（OR = 0.968、P = 0.018）均为肩关节镜术后感染的独立危险因素。ROC曲线分析显示，肩关节镜术后糖皮质激素的累计治疗时间ROC曲线下面积为0.805，95%CI：0.685～0.924，临界值为5.16；肩关节镜术后糖皮质激素日均剂量ROC曲线下面积为0.909，95%CI：0.830～0.988，临界值为12.67，差异均有统计学意义（P均< 0.001）。

结论

肩关节镜术后感染以革兰阳性菌为主，长时间与高剂量糖皮质激素注射可能会导致术后感染的风险增高。肩关节镜术后合理应用糖皮质激素是避免感染发生的重要措施。

关键词: 肩关节镜, 糖皮质激素, 感染
Objective

To investigate the effect of glucocorticoid injection period and dose on postoperative infection after shoulder arthroscopy, and to provide new ideas for prevention and treatment of complications after shoulder arthroscopy.

Methods

Total of 94 patients who were treated in Puning People’s Hospital and underwent shoulder arthroscopic surgery from February 2014 to March 2018 were selected, according to with or without postoperative infection, the patients were divided into infected group (21 cases) and uninfected group (73 cases), and the incidence of infection and distribution of pathogenic bacteria were analyzed, respectively. The correlation between age, gender, hospitalization days, operation time, glucocorticoid use and rate of postoperative infection were analyzed, respectively. The time and dose of glucocorticoid therapy were recorded. The influences of time and dose of glucocorticoid injection on infection after shoulder arthroscopy were predicted by ROC curve.

Results

There were 21 patients with infection after shoulder arthroscopy, and the infection rate was 22.3%, among which, 8 strains (38.0%) of Gram-negative bacteria, 12 strains (57.2%) of Gram-positive bacteria, and 1 strain (4.8%) of fungi were isolated. Compared with uninfected group, the age, hospitalization days, operation time, diabetes mellitus, antimicrobial use time, daily dose and time difference of glucocorticoid treatment were significantly different in the infected group (all P < 0.05). Multivariate Logistic regression analysis showed that operation time (OR = 1.238, P = 0.026), daily average dose of glucocorticoid (OR = 1.485, P = 0.019) and using time (OR = 0.968, P = 0.018) were all independent risk factors for postoperative infection. The area under ROC curve of glucocorticoid cumulative treatment time after shoulder arthroscopy was 0.805, 95% confidence interval (CI) was 0.685-0.924, and cut-off value was 5.16. The area under ROC curve of daily average dose of glucocorticoid after shoulder arthroscopy was 0.909, 95%CI was 0.830-0.988, and cut-off value was 12.67, all with significant differences (all P < 0.001).

Conclusions

Gram-positive bacteria were the main pathogen after shoulder arthroscopy. Long-term and high-dose glucocorticoid injection may increase the risk of infection after shoulder arthroscopy. Therefore, reasonable and efficient use of glucocorticoids after shoulder arthroscopy was important to avoid infection.

Key words: Shoulder arthroscopy, Glucocorticoid, Infection
表1 肩关节镜术后感染的病原菌分布
病原菌 株数 构成比（%）
革兰阴性菌 8 38.0
? 鲍曼不动杆菌 2 9.5
? 大肠埃希菌 5 23.7
? 丙酸杆菌 1 4.8
革兰阳性菌 12 57.2
? 金黄色葡萄球菌 6 28.7
? 表皮葡萄球菌 4 19.0
? 溶血链球菌 2 9.5
真菌 1 4.8
? 白假丝酵母菌 1 4.8
表2 肩关节镜术后患者并发感染的单因素分析
影响因素 感染组（21例） 未感染组（73例） χ2值 P值
性别[例（%）] ? ? 0.170 0.805
? 男 9（42.9） 35（47.0） ? ?
? 女 12（57.1） 38（53.0） ? ?
年龄分布[例（%）] ? ? 4.283 0.034
? < 55岁 7（64.3） 43（48.5） ? ?
? ≥ 55岁 14（35.7） 30（51.5） ? ?
住院时间（±s，d） 17.35 ± 4.24 12.91 ± 6.28 18.357 0.001
手术时间（±s，min） 145.42 ± 23.61 105.95 ± 28.67 21.672 < 0.001
肩关节疾病种类[例（%）] ? ? 0.156 0.984
? 粘连性肩关节炎 5（35.7） 20（30.3） ? ?
? 钙化性冈上肌肌腱炎 3（21.4） 14（21.2） ? ?
? 肩关节滑膜炎 4（28.6） 20（30.3） ? ?
? 肩关节骨性关节炎 2（14.3） 12（18.2） ? ?
合并糖尿病[例（%）] ? ? 12.195 0.001
? 是 14（71.4） 18（31.8） ? ?
? 否 7（28.6） 55（68.2） ? ?
抗菌药物使用时间（±s，d） 13.26 ± 3.75 5.52 ± 3.03 28.648 < 0.001
糖皮质激素治疗 ? ? ? ?
? 累积治疗时间（±s，d） 7.57 ± 1.52 3.67 ± 1.45 19.572 < 0.001
? 日均治疗剂量（mg/d) 19.08 ± 5.27 8.57 ± 3.23 17.579 < 0.001
表3 肩关节镜术后患者感染的多因素Logistic回归分析
影响因素 β值 标准误 Wald χ2值 P值 OR值 95%CI值
手术时间 0.648 1.096 7.348 0.026 1.238 1.116～2.368
糖皮质激素治疗时间 0.968 0.749 8.672 0.019 0.968 0.438～1.529
糖皮质激素治疗日均剂量 0.709 0.937 8.064 0.018 1.485 0.945～1.973
图1 糖皮质激素注射时间和剂量对肩关节镜术后感染影响的ROC曲线
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