人工膝关节置换术后发热特点及趋势的相关分析

背景：围手术期发热在人工膝关节置换术患者中十分常见，但关节术后感染尤其是假体周围感染可产生灾难性后果，因此骨科医师对其患者术后发热仍难免特别担心。 目的：探讨人工膝关节置换术后发热的相关特点和趋势，以及人工膝关节置换术后发热与感染等因素的潜在关系。 方法：回顾性分析2009年7月至2012年5月行膝关节置换术的700例患者的病历资料。详细记录每例患者术前1 d至术后10 d每天的最高体温，术后血红蛋白丢失量、是否输血、麻醉方式、是否发生感染及感染类型等。 结果：351例（50.1%）人工膝关节置换术患者出现术后发热。在发热患者中，第1次发热症状最常出现在术后第1天（204例，占所有发热病例数的58.1%），手术当日（55例，15.7%）和术后第2天（62例，17.7%）次之。整个住院期间的最高体温最常出现在术后第1天（168例，47.9%）、第2天（125例，35.6%）。25例（3.6%）患者发生术后感染事件，术后发热与感染事件、输血显著相关；与年龄、性别、血红蛋白丢失、麻醉方式等因素之间没有显著的相关性。在感染事件中，呼吸系感染最易引起术后发热。 结论：人工膝关节置换术患者术后发热与感染事件、输血明显相关，而连续发热、超过39℃的发热尤其需要引起医师对术后感染的警惕。

Postoperative pyrexia trends in patients who underwent total knee arthroplasty

Background： Pyrexia after total knee arthroplasty （TKA） is a very common phenomenon. Although it is widely accepted, worries usually arise because the consequences of the possible infection are somehow catastrophic. 〈br〉 Objective：To study the trends of febrile response after TKA and the correlation between postoperative pyrexia and infection. 〈br〉 Methods：A retrospective study was conducted in 700 patients who underwent TKA from July 2009 to May 2012. Body tem-perature （day 1 before surgery, and day 0 to day 10 after surgery）, deprived hemoglobin, blood transfusion, anesthetic meth-od and infection were recorded. 〈br〉 Results：Of the 700 patients, 351 （50.1%） experienced pyrexia in the postoperative period. Pyrexia occurred on day 1 postop-eratively in 204 cases, on operative day in 55 cases and on day 2 postoperatively in 62 cases. The maximum temperature throughout the whole hospitalization was most likely to occur on day 1 （168 cases） and day 2 （125 cases） postoperatively. Postoperative infection occurred in 25 （3.6%） TKA patients. Pyrexia was statistically related to infectious events and transfu-sion, but not significantly related to age, gender, hemoglobin deprived and anesthetic method. The respiratory infection was most closely related to pyrexia in TKA. 〈br〉 Conclusions：Infectious events and blood transfusion are statistically correlated with postoperative fever. Consecutive fever and fever over 39℃should cause necessary concerns of suspected infection.