系统性红斑狼疮患者行人工全髋关节置换术的术后早期安全性研究

Early Postoperative Safety of Total Hip Arthroplasty in Systemic Lupus Erythematosus Patients

  • 摘要:
    目的 探究系统性红斑狼疮(systemic lupus erythematosus, SLE)患者接受人工全髋关节置换术(total hip arthroplasty,THA)术后30 d内的安全性。
    方法 回顾性连续纳入2012年6月—2024年4月于北京协和医院接受THA的患者资料,以患者是否伴发SLE分为SLE组和对照组。采用倾向性评分法对两组患者的性别、年龄、手术侧别以1∶1比例进行匹配,比较两组临床特征、术后30 d内主要并发症发生率及同种异体红细胞输注率。
    结果 共入选符合纳入与排除标准的SLE组患者270例,术后30 d内发生并发症18例(6.67%),包括上呼吸道感染2例(0.74%)、肺部感染2例(0.74%)、泌尿系统感染3例(1.11%)、其他系统感染2例(0.74%)、切口愈合不良5例(1.85%)、切口感染1例(0.37%)、消化系统并发症1例(0.37%)、休克1例(0.37%)、SLE活动1例(0.37%),同种异体红细胞输注率为22.59%(61/270)。经倾向性评分匹配后,SLE组和对照组各163例纳入分析:(1)内科合并症方面,与对照组相比,SLE组在骨质疏松、呼吸系统、消化系统、泌尿系统、血液系统和继发或伴发其他风湿性疾病方面具有明显差异(P均<0.05)。(2)术前实验室检查方面,SLE组血小板、淋巴细胞计数、血红蛋白、红细胞压积、白蛋白、血糖和活化部分凝血活酶时间均较对照组低,而C反应蛋白、红细胞沉降率和D-二聚体水平较高(P均<0.05)。(3)手术相关指标方面,SLE组“美国麻醉医师协会分级>2”患者比例更高(15.95%比3.07%,P<0.001),但术中出血量更少324.7(200.0, 500.0)mL比421.8(200.0, 500.0)mL,P=0.005。(4)并发症方面,SLE组主要并发症发生率高于对照组(8.59%比1.23%,P=0.005),相对危险度为1.081(95% CI: 1.028~1.136),SLE组同种异体红细胞输注率与对照组无明显差异(25.77%比17.18%,P=0.059)。
    结论 SLE患者接受THA术后30 d主要并发症发生率显著高于非SLE患者,但同种异体红细胞输注率相当。为保证SLE患者THA手术安全性,应尽可能在术前将患者病情控制稳定,并实施严格的围术期管理。

     

    Abstract:
    Objective To analyze the occurrence of early complications after total hip arthroplasty (THA) in patients with systemic lupus erythematosus (SLE).
    Methods The data of patients who underwent THA at Peking Union Medical College Hospital from June 2012 to April 2024 were retrospectively and consecutively collected. The patients were categorized into SLE group and control group based on the presence or absence of SLE. Using propensity score matching, we matched patients in the two groups at a 1∶1 ratio according to gender, age, and surgical side. Subsequently, we compared the clinical characteristics, incidence of major complications within 30 days postoperatively, and allogeneic blood transfusion rates between the two groups.
    Results A total of 270 patients in the SLE group who met the inclusion and exclusion criteria were selected. Within 30 days postoperatively, 18 cases (6.67%) experienced major complications, including 2 cases (0.74%) of upper respiratory tract infection, 2 cases (0.74%) of pulmonary infection, 3 cases (1.11%) of urinary tract infection, 2 cases (0.74%) of other systemic infection, 5 cases (1.85%) of poor wound healing, 1 case (0.37%) of wound infection, 1 case (0.37%) of gastrointestinal complications, 1 cases (0.37%) of shock, and 1 case (0.37%) of SLE flare-up. The allogeneic blood transfusion rate was 22.59% (61/270). After propensity score matching, 163 cases from SLE and control groups were included for analysis. (1) Regarding medical complications, compared with control group, SLE group showed significant differences in osteoporosis, respiratory system disorders, gastrointestinal diseases, urinary system disorders, hematologic abnormalities, and secondary or concomitant rheumatic diseases (all P < 0.05). (2) In terms of preoperative laboratory tests, SLE group had lower platelet counts, absolute lymphocyte counts, hemoglobin levels, hematocrit, albumin levels, blood glucose levels, and activated partial thromboplastin times than control group, while C-reactive protein, erythrocyte sedimentation rate, and D-dimer levels were higher (all P < 0.05). (3) Regarding surgical-related indicators, a higher proportion of patients in SLE group had an ASA grade > 2 (15.95% vs. 3.07%, P < 0.001), but intraoperative blood loss was significantly smaller 324.7 (200.0, 500.0) mL vs. 421.8 (200.0, 500.0) mL, P=0.005. (4) In terms of complications, SLE group exhibited a significantly higher incidence of major complications than control group (8.59% vs. 1.23%, P=0.005), with a relative risk of 1.081 (95% CI: 1.028-1.136). No significant difference was observed in the allogeneic blood transfusion rate between SLE group and control group (25.77% vs. 17.18%, P=0.059).
    Conclusions The incidence of major complications within 30 days following THA in patients with SLE was significantly higher than that in non-SLE patients, while the rate of allogeneic blood transfusion remained comparable. To ensure the safety of THA surgery for patients with SLE, it is important to optimize the patient's condition and achieve stabilization prior to surgery. Additionally, strict perioperative management must be forced.

     

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