脊柱结核患者术后手术部位感染影响因素分析
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摘要
目的分析脊柱结核术后手术部位感染的影响因素,为临床防控提供参考。方法选择2011年2月-2018年9月收治的672例脊柱结核手术患者为研究对象,调查患者年龄、性别、病程、初治还是复治、病变部位、是否应用内置物、术前抗结核化疗时间、化疗是否规范、有无骨外结核、病灶范围、有无糖尿病史、BMI值、切口大小、手术时间、出血量、病灶清除是否彻底等临床资料,对其发生手术部位感染的相关因素进行单因素及多因素Logistic回归分析。结果 672例脊柱结核手术患者中发生手术部位感染54例,手术部位感染率为8.04%;Logistic回归模型分析显示,化疗不规范、病灶清除不彻底、切口引流、检出耐多药结核分枝杆菌、血清白蛋白浓度<30g/L、血糖≥11.1mmol/L、血沉≥20mm/h是脊柱结核术后手术部位感染的独立危险因素(P<0.05)。结论脊柱结核术后手术部位感染与多因素相关,临床应采取针对干预措施,降低脊柱结核术后手术部位感染率。
OBJECTIVE To analyze the risk factors of surgical site infection after spinal tuberculosis operation,and provide reference for clinical prevention and control.METHODS A total of 672 patients with spinal tuberculosis surgery who were admitted from Feb.2011 to Sep.2018 were slected as the subjects.The clinical data of the patients such as age,gender,course of disease,initial treatment or re-treatment,lesion location,use of implants,preoperative anti-tuberculosis chemotherapy time,standardization of chemotherapy,occurrence of extra-abdominal tuberculosis,extent of the lesion,history of diabetes,BMI,size of the incision,operation duration,amount of bleeding,thoroughness of lesion removalwere investigated,and the risk factors of the surgical site infection were analyzed by univariate and multivariate Logistic regression analyses.RESULTS Of the 672 patients with tuberculosis,54 cases of surgical site infection occurred,and the infection rate was 8.04%.Logistic regression model analysis showed that unstandardized chemotherapy,incomplete lesion removal,incision drainage,detection of multidrug-resistant M.tuberculosis,serum albumin concentration<30 g/L,blood glucose≥11.1 mmol/L,and erythrocyte sedimentation rate≥20 mm/h were independent risk factors for surgical site infection after spinal tuberculosis operation(P<0.05).CONCLUSIONSurgical site infection after spinal tuberculosis operation is associated with multiple factors,and clinical intervention measures should be taken to reduce the infection rate of surgical sites after spinal tuberculosis operation.
OBJECTIVE To analyze the risk factors of surgical site infection after spinal tuberculosis operation,and provide reference for clinical prevention and control.METHODS A total of 672 patients with spinal tuberculosis surgery who were admitted from Feb.2011 to Sep.2018 were slected as the subjects.The clinical data of the patients such as age,gender,course of disease,initial treatment or re-treatment,lesion location,use of implants,preoperative anti-tuberculosis chemotherapy time,standardization of chemotherapy,occurrence of extra-abdominal tuberculosis,extent of the lesion,history of diabetes,BMI,size of the incision,operation duration,amount of bleeding,thoroughness of lesion removalwere investigated,and the risk factors of the surgical site infection were analyzed by univariate and multivariate Logistic regression analyses.RESULTS Of the 672 patients with tuberculosis,54 cases of surgical site infection occurred,and the infection rate was 8.04%.Logistic regression model analysis showed that unstandardized chemotherapy,incomplete lesion removal,incision drainage,detection of multidrug-resistant M.tuberculosis,serum albumin concentration<30 g/L,blood glucose≥11.1 mmol/L,and erythrocyte sedimentation rate≥20 mm/h were independent risk factors for surgical site infection after spinal tuberculosis operation(P<0.05).CONCLUSIONSurgical site infection after spinal tuberculosis operation is associated with multiple factors,and clinical intervention measures should be taken to reduce the infection rate of surgical sites after spinal tuberculosis operation.
引文
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[10]许楠健,陈云琳,蒋伟宇,等.后路经皮螺钉固定联合局部经皮内窥镜下病灶清除治疗老年脊柱结核[J].中国骨伤,2018,31(11):1005-1011.
[11]刘宇红,高微微,李亮,等.单耐药和多耐药复治菌阳肺结核个体化治疗效果探讨[J].中华结核和呼吸杂志,2018,41(1):25-31.
[12]杨启远,冯敬,杨雯栋,等.后路一期病灶清除结合内固定治疗多节段脊柱结核[J].实用骨科杂志,2016,22(4):293-297,298.
[13]胡涛,许勇,陈邵站,等.脊柱术后早期手术部位感染患者持续闭合灌洗引流治疗的疗效分析[J].中华医院感染学杂志,2016,26(4):870-872.
[14]胡妙仙,谢红燕,朱海飞,等。急诊外科胸腹部创伤手术后切口感染的病原菌分布及相关危险因素分析[J].中华医院感染学杂志,2017,27(1):128-131.
[15]Watanabe M,Suzuki H,Nomura S,et al.Risk factors for surgical site infection in emergency colorectal surgery:a retrospective analysis[J].Surg Infect(Larchmt),2014,15(3):256-261.
[16]Sanabria A,Vega V,Dominguez LC,et al.The evolution of laparoscopy in abdominal surgery:a meta-analysis of the effect on infectious outcomes[J].Minim Invasive Ther Allied Technol,2014,23(2):74-86.
[17]Tserenpuntsag B,Haley V,Van Antwerpen C,et al.Surgical site infection risk factors identified for patients undergoing colon procedures,New York State 2009-2010[J].Infect Control Hosp Epidemiol,2014,35(8):1006-1012.
[18]史多琦,闫军伟,张明金,等.2013-2015年我国普通外科术后切口感染率及其相关危险因素分析[J].中华医院感染学杂志,2016,26(23):5436-5443.
[2]Izawa K,Histological analysis of bone destruction in spinal tuberculosis[J].Kekkaku,2015,90(3):415-420.
[3]何清义,周强,卢宏伟,等.儿童胸腰椎结核手术治疗的效果及并发症分析[J].中国脊柱脊髓杂志,2015,25(9):820-825.
[4]中华医学会.临床诊疗指南:结核病分册[S].北京:人民卫生出版社,2005:29.
[5]中华人民共和国卫生部.外科手术部位感染预防与控制技术指南(试行)[S].北京:中华人民共和国卫生部,2010:23.
[6]许建中.规范脊柱结核治疗,为我国结核病防治做出更大贡献[J].中华骨科杂志,2014,34(2):97-101.
[7]He M,Xu H,Zhao JM,et al.Anterior debridement,decompression,bone grafting,and instrumentation for lower cervical spine tuberculosis[J].Spine J,2014,14(4):619-627.
[8]买尔旦·买买提,荀传辉,张健,等.一期经后路病灶清除、Smith-Petersen截骨加压融合术治疗胸、腰椎结核[J].中华骨科杂志,2018,38(4):228-235.
[9]孙健,杨剑,杨进孙,等.172例年轻初治Ⅲ型肺结核耐药状况和抗痨效果调查分析[J].中国人兽共患病学报,2018,34(11):1059-1062.
[10]许楠健,陈云琳,蒋伟宇,等.后路经皮螺钉固定联合局部经皮内窥镜下病灶清除治疗老年脊柱结核[J].中国骨伤,2018,31(11):1005-1011.
[11]刘宇红,高微微,李亮,等.单耐药和多耐药复治菌阳肺结核个体化治疗效果探讨[J].中华结核和呼吸杂志,2018,41(1):25-31.
[12]杨启远,冯敬,杨雯栋,等.后路一期病灶清除结合内固定治疗多节段脊柱结核[J].实用骨科杂志,2016,22(4):293-297,298.
[13]胡涛,许勇,陈邵站,等.脊柱术后早期手术部位感染患者持续闭合灌洗引流治疗的疗效分析[J].中华医院感染学杂志,2016,26(4):870-872.
[14]胡妙仙,谢红燕,朱海飞,等。急诊外科胸腹部创伤手术后切口感染的病原菌分布及相关危险因素分析[J].中华医院感染学杂志,2017,27(1):128-131.
[15]Watanabe M,Suzuki H,Nomura S,et al.Risk factors for surgical site infection in emergency colorectal surgery:a retrospective analysis[J].Surg Infect(Larchmt),2014,15(3):256-261.
[16]Sanabria A,Vega V,Dominguez LC,et al.The evolution of laparoscopy in abdominal surgery:a meta-analysis of the effect on infectious outcomes[J].Minim Invasive Ther Allied Technol,2014,23(2):74-86.
[17]Tserenpuntsag B,Haley V,Van Antwerpen C,et al.Surgical site infection risk factors identified for patients undergoing colon procedures,New York State 2009-2010[J].Infect Control Hosp Epidemiol,2014,35(8):1006-1012.
[18]史多琦,闫军伟,张明金,等.2013-2015年我国普通外科术后切口感染率及其相关危险因素分析[J].中华医院感染学杂志,2016,26(23):5436-5443.