JBJS:糖尿病患者全膝关节置换术后并无过高感染风险
2013-03-20 mhbjq123 丁香园
《骨关节外科杂志》(JBJS)在线公布的一项新研究结果表明,全膝关节置换术(TKR)后的伴糖尿病患者较非糖尿病患者相比并无更高的感染、深静脉血栓(一种深静脉的血凝块)或者其他并发症风险,相关结果稍后将发表在该杂志2013年3月版上。该研究的作者们试图判定是否血糖水平(血糖控制水平)可以影响TKR患者的预后。52%的糖尿病患者有关节炎病史。先前的研究发现血糖控制不佳可以导致术后并发症的产生。研究者们
《骨关节外科杂志》(JBJS)在线公布的一项新研究结果表明,全膝关节置换术(TKR)后的伴糖尿病患者较非糖尿病患者相比并无更高的感染、深静脉血栓(一种深静脉的血凝块)或者其他并发症风险,相关结果稍后将发表在该杂志2013年3月版上。
该研究的作者们试图判定是否血糖水平(血糖控制水平)可以影响TKR患者的预后。52%的糖尿病患者有关节炎病史。先前的研究发现血糖控制不佳可以导致术后并发症的产生。
研究者们回顾了2001年1月至2009年12月期间在凯撒医疗机构接受TKR治疗的40000名患者的记录资料,这些患者中有7567(18.7%)人伴有糖尿病,464(1.1%)人又接受了翻修手术,287(0.7%)人术后发生了深部组织感染。在所有患者当中,12.5%血糖控制良好,而6.2%血糖控制不佳。
在这项研究中研究者们发现,无论血糖控制状况良好与否,伴糖尿病患者TKR术后的翻修、感染或深静脉血栓风险并不高于非糖尿病患者。
其他重要发现:
相比较于非糖尿病患者,糖尿病患者更易于肥胖(56.7%:40.3%),有更高的并存病(相关的疾病或健康状况)风险(17.5%:2.4%)。
与非糖尿病患者相比,血糖控制良好或不佳的伴糖尿病患者深部感染、深静脉血栓和肺栓塞(当血凝块到达肺时造成)发生率也较低。
糖尿病控制不佳似乎不造成更高的心肌梗死(心脏病发作)和再次入院率。
控制良好与控制不佳的伴糖尿病患者相比术后翻修的几率略有增高。
“本次研究提示有较高血糖水平的伴糖尿病患者可能并不引起差的手术预后。”凯撒医疗机构南加州研究与评估部的理学博士、公卫学硕士Annette L. Adams说。“可能有其他因素在起作用,在决定是否要采用关节置换术时,病人和关节供应商需要考虑多种因素,包括但不仅限于病人的糖尿病状态。”
与糖尿病相关的拓展阅读:
Background:
Poor glycemic control in patients with diabetes may be associated with adverse surgical outcomes. We sought to determine the association of diabetes status and preoperative glycemic control with several surgical outcomes, including revision arthroplasty and deep infection.
Methods:
We conducted a retrospective cohort study in five regions of a large integrated health-care organization. Eligible subjects, identified from the Kaiser Permanente Total Joint Replacement Registry, underwent an elective first primary total knee arthroplasty during 2001 through 2009. Data on demographics, diabetes status, preoperative hemoglobin A1c (HbA1c) level, and comorbid conditions were obtained from electronic medical records. Subjects were classified as nondiabetic, diabetic with HbA1c < 7% (controlled diabetes), or diabetic with HbA1c ≥ 7% (uncontrolled diabetes). Outcomes were deep venous thrombosis or pulmonary embolism within ninety days after surgery and revision surgery, deep infection, incident myocardial infarction, and all-cause rehospitalization within one year after surgery. Patients without diabetes were the reference group in all analyses. All models were adjusted for age, sex, body mass index, and Charlson Comorbidity Index.
Results:
Of 40,491 patients who underwent total knee arthroplasty, 7567 (18.7%) had diabetes, 464 (1.1%) underwent revision arthroplasty, and 287 (0.7%) developed a deep infection. Compared with the patients without diabetes, no association between controlled diabetes (HbA1c < 7%) and the risk of revision (odds ratio [OR], 1.32; 95% confidence interval [CI], 0.99 to 1.76), risk of deep infection (OR, 1.31; 95% CI, 0.92 to 1.86), or risk of deep venous thrombosis or pulmonary embolism (OR, 0.84; 95% CI, 0.60 to 1.17) was observed. Similarly, compared with patients without diabetes, no association between uncontrolled diabetes (HbA1c ≥ 7%) and the risk of revision (OR, 1.03; 95% CI, 0.68 to 1.54), risk of deep infection (OR, 0.55; 95% CI 0.29 to 1.06), or risk of deep venous thrombosis or pulmonary embolism (OR, 0.70; 95% CI, 0.43 to 1.13) was observed.
Conclusions:
No significantly increased risk of revision arthroplasty, deep infection, or deep venous thrombosis was found in patients with diabetes (as defined on the basis of preoperative HbA1c levels and other criteria) compared with patients without diabetes in the study population of patients who underwent elective total knee arthroplasty.
作者:mhbjq123
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