腰椎后路内固定术后早期深部感染的危险因素分析

发布时间：2018-06-08 00:06

本文选题：腰椎内固定 + 术后感染　；参考：《广西医科大学》2016年硕士论文

【摘要】：目的研究、发现及分析腰椎后路减压、钉棒系统内固定、融合术后早期深部感染的危险因素,以期为临床诊疗提供参考,预防术后感染,降低术后感染率、节约医疗资源。方法通过对广西壮族自治区人民医院骨外科脊柱骨病病区,于2014年1月至2015年12月期间行开放腰椎后路减压、内固定、融合术的患者的病历资料收集如：年龄、性别、高血压、糖尿病、术前及术后白蛋白、术前及术后血红蛋白、手术责任节段数、手术时间、术中失血量、输同种异体血、预防性使用抗生素时间以及放置引流管时间等相关病历资料,进行回顾性研究分析。计数资料采取组间卡方检验分析并筛选出术后早期深部感染的危险因素,多因素分析采取二元Logistic回归分析术后早期深部感染的主要危险因素。结果本次研究发现,在2014年1月至2015年12月期间,我院行腰椎后路减压、钉棒系统内固定、融合术后早期深部感染的发生率为3.55%。其中发生术后深部感染的有12例。其中年龄、高血压、术后血红蛋白、手术责任节段数、手术时间、输血、出血量、放置引流管时间长短是腰椎后路减压、内固定、融合术后早期深部感染的危险因子。经多因素二元Logistic回归分析发现：放置引流管时间长短、手术责任节段数是腰椎后路减压、内固定、融合术后早期深部感染发生的主要危险因子。而性别、糖尿病、预防性使用抗生素时间长短、术前白蛋白、术后白蛋白、术前血红蛋白均不是腰椎后路减压、内固定、融合术后早期深部感染的危险因子。结论1.在年龄无法干预的情况下,调整好患者术前、术后的血压状态,改善患者术后血红蛋白、低蛋白血症,可以有效预防患者发生术后早期深部感染。2.对于手术责任节段数无法避免长节段时,尽量缩短手术时间,减少出血量,术中行自体血回输等均可有效预防术后早期深部感染。
[Abstract]:Objective to find out and analyze the risk factors of posterior lumbar decompression, nail and rod system fixation and early deep infection after operation, so as to provide reference for clinical diagnosis and treatment, to prevent postoperative infection, to reduce postoperative infection rate and to save medical resources. Methods from January 2014 to December 2015, we collected the medical records of patients undergoing open lumbar decompression, internal fixation and fusion in the Department of Spinal Osteopathy, the people's Hospital of Guangxi Zhuang Autonomous region, such as age, sex and hypertension. Diabetes mellitus, preoperative and postoperative albumin, preoperative and postoperative hemoglobin, number of responsible segments of surgery, operative time, intraoperative blood loss, allogeneic blood transfusion, prophylactic use of antibiotics and time of placement of drainage tubes, etc. To carry out retrospective study and analysis. The count data were analyzed by chi-square test among groups and the risk factors of early deep infection were screened out. Multivariate logistic regression analysis was used to analyze the main risk factors of early deep infection after operation. Results during the period from January 2014 to December 2015, the incidence of early deep infection after fusion was 3.55%. Among them, there were 12 cases of deep infection after operation. Age, hypertension, postoperative hemoglobin, the number of operative segments, operative time, blood transfusion, blood loss, and the time of placement of drainage tube were the risk factors of early deep infection after lumbar posterior decompression, internal fixation and fusion. By multivariate logistic regression analysis, it was found that the length of drainage tube placement and the number of responsible segments were the main risk factors for early deep infection after lumbar posterior decompression, internal fixation and fusion. Sex, diabetes, duration of prophylactic use of antibiotics, preoperative albumin, postoperative albumin and preoperative hemoglobin were not risk factors for early deep infection of lumbar spine. Conclusion 1. In the case of age can not intervene, adjust the preoperative and postoperative blood pressure status, improve postoperative hemoglobin, hypoproteinemia, can effectively prevent early postoperative deep infection. 2. When the number of responsible segments can not be avoided, the operation time can be shortened, the amount of blood lost and the autologous blood transfusion can be used to prevent early deep infection after operation.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R687.3

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