腰椎后路术后切口感染的相关危险因素分析

发布时间：2018-05-22 18:08

本文选题：腰椎 + 白蛋白　；参考：《南昌大学》2017年硕士论文

【摘要】：目的:分析腰椎后路手术后切口感染发生情况及其相关危险因素,为临床预防提供参考。方法:回顾性分析2010年1月至2016年8月因腰椎疾病在我院行腰椎后路手术治疗的2715例患者的临床资料,包括腰椎间盘突出症1075例(39.59%),腰椎滑脱症611例(22.50%),腰椎椎管狭窄症580例(21.36%),腰椎骨折449例(16.54%)。按性别、体重指数、主要诊断等进行匹配,从同期行腰椎后路手术患者的数据库中按3:1比例选择术后无并发症的患者作为对照组进行数据分析。记录并分析患者年龄、合并症、手术方式、手术时间、术中失血量、术中输血情况、手术节数、术前及术后血细胞分析、肝肾功能、电解质和术后拔除引流管时间与切口感染的关系。采用SPSS19.0统计软件对计量资料采用t检验分析;对计数资料采用X2检验或Fisher确切概率检验进行比较。对每个单因素分析得出有统计学意义的变量再用多因素分析,将以P0.05为差异具有统计学意义。结果:总共64例(2.36%)患者术后发生切口感染,其中男性46例,女性18例,年龄27-77岁,手术年龄58.30±10.44岁。原始疾病为椎间盘突出症18例,腰椎滑脱11例,腰椎椎管狭窄21例,腰椎骨折14例。单因素分析显示:术前合并糖尿病;术前红细胞、血红蛋白、总蛋白、白蛋白、血清钙;手术方式、手术时间、麻醉时间、手术节数、术中出血量、麻醉等级;术后红细胞、血红蛋白、白蛋白、球蛋白、血小板、血清钙和拔管时间与对照组相比差异具有统计学意义(P0.05)。进一步二分类Logistic回归分析显示:术前合并糖尿病(OR=2.488,P=0.020)、术前白蛋白下降(OR=0.863,P=0.017)、术前血清钙下降(OR=0.018,P=0.007)、手术节数(OR=2.329,P=0.000)、术后血红蛋白降低(OR=0.950,P=0.008)、术后白蛋白降低(OR=0.897,P=0.035)、术后球蛋白升高(OR=1.082,P=0.008)和拔出引流管时间延长(OR=1.493,P=0.016)是腰椎术后切口感染的独立危险因素。结论:糖尿病、术前白蛋白下降、术前血清钙下降、手术节数、术后血红蛋白降低、术后白蛋白降低、术后球蛋白升高和拔出引流管时间延长是腰椎后路术后切口感染的重要危险因素。围手术期应注意处理术前合并症,监测血红蛋白、白蛋白、球蛋白和电解质的变化,有助于预防腰椎术后切口感染的发生。
[Abstract]:Objective: to analyze the incidence and risk factors of incision infection after lumbar posterior approach surgery, and to provide reference for clinical prevention. Methods: the clinical data of 2715 patients with lumbar spine disease treated by posterior lumbar surgery from January 2010 to August 2016 were retrospectively analyzed. There were 1075 cases of lumbar disc herniation, 611 cases of lumbar spondylolisthesis, 580 cases of lumbar spinal stenosis, and 449 cases of lumbar fracture. According to gender, body mass index (BMI) and main diagnosis, the data were analyzed from the database of patients undergoing lumbar posterior approach operation in the same period. The patients without complications were selected as the control group according to the 3:1 ratio. To record and analyze the patients' age, complications, operative methods, operative time, intraoperative blood loss, blood transfusion during operation, number of operative segments, blood cell analysis before and after operation, liver and kidney function. The relationship between electrolyte and the time of pulling out drainage tube after operation and wound infection. The SPSS19.0 statistical software was used to analyze the measurement data by t-test, and the count data was compared by using X2 test or Fisher exact probability test. For each single factor analysis, the variables with statistical significance were analyzed with multivariate analysis, and the difference was statistically significant with P0.05. Results: a total of 64 patients (male 46, female 18, age 27-77, operative age 58.30 卤10.44) developed incision infection after operation. The primary diseases included intervertebral disc herniation (18 cases), lumbar spondylolisthesis (11 cases), lumbar spinal stenosis (21 cases) and lumbar fracture (14 cases). Univariate analysis showed that: preoperative diabetes mellitus; preoperative erythrocyte, hemoglobin, total protein, albumin, serum calcium; operation mode, operation time, anesthetic time, number of operative segments, intraoperative bleeding, anesthetic grade; postoperative red blood cell, Hemoglobin, albumin, globulin, platelet, serum calcium and extubation time were significantly different from the control group (P 0.05). Further two classification Logistic regression analysis showed: preoperative diabetes complicated with OR 2.488 P0.020, preoperative albumin decreased OR0.863P0. 017, preoperative serum calcium decreased OR0. 018 P0. 007, operation section decreased OR0.950 P0. 008, postoperative albumin decreased OR0. 897 P0. 035, globulin increased OR1. 082 P0. 008). Prolongation of drainage tube time was an independent risk factor for incision infection after lumbar vertebra operation. Conclusion: in diabetes mellitus, the preoperative albumin, the preoperative serum calcium, the number of operative segments, the postoperative hemoglobin and the postoperative albumin were decreased. Elevated globulin and prolonged drainage time are important risk factors for postoperative incision infection. Perioperative management should be paid attention to preoperative complications, monitoring the changes of hemoglobin, albumin, globulin and electrolyte, which is helpful to prevent postoperative incision infection.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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