腰椎后路术后感染原因分析及处理措施

Causes of infections after lumbar posterior surgery and treatment measures

目的探讨腰椎后路手术术后感染的危险因素与预防治疗对策,以期为临床提供借鉴,降低感染发生率。方法回顾性分析近期收治的行腰椎后路手术的患者临床资料,包括患者感染的病因、临床表现、诊断依据、治疗方法等,并进行单因素及多因素分析与制定预防治疗对策。结果单因素分析发现,手术操作的熟练程度低(OR=1.769,95%CI:1.420～2.115)、患者身体健康状态差(OR=6.447,95%CI:1.826～22.769)等是感染的主要病因;以细菌培养作为术后感染的金标准,血沉(OR=1.863,95%CI:1.709～2.051)、C反应蛋白(OR=1.53995%CI:1.042～2.635)是诊断术后感染的敏感化指标;敏感抗菌药物(OR=0.640,95%CI:0.169～0.956)+病灶清创灌洗引流(OR=0.130,95%CI:0.069～0.913)等是治疗的主要方法。结论对于腰椎后路手术术后感染,血沉及C-反应蛋白的升高可作为细菌培养之前的诊断因素,患者的身体状况、手术操作的熟练程度低为相关的危险因素,所以应该密切观察患者血沉及C-反应蛋白以检测患者的术后感染情况,其次加强患者的营养提高其免疫力,其次减少患者手术暴露时间,以降低术后感染的可能性,对于已感染的患者,应予以敏感抗菌药物、病灶清创灌洗引流以提高治愈率。

OBJECTIVE To study the risk factors of infections after lumbar posterior surgery and put forward the prevention countermeasures so as to guide the clinical treatment and reduce the incidence of infections.METHODS The clinical data of the patients who recently underwent the lumbar posterior surgery were retrospectively analyzed,including the causes of infections,clinical manifestations,diagnostic bases,and treatment methods,then the univariate analysis and multivariate analysis were performed,and the prevention countermeasures were put forward.RESULTS The univariate analysis indicated that the low operation proficiency（OR=1.769,95% CI：1.420 2.115）and the poor health state（OR=6.447,95% CI：1.826 22.769）were the main causes of the infections.Taken the bacterial culture as the gold standard of postoperative infections,erythrocyte sedimentation rate（OR=1.863,95% CI：1.709 2.051）,and C-reactive protein（OR=1.539 95% CI：1.042 2.635）were the sensitive indicators of the diagnosis of postoperative infections.The sensitive antibiotics（OR=0.640,95% CI： 0.169 0.956）plus lesions debridement lavage drainage（OR=0.130,95%CI：0.069 0.913）were the main treatment measures.CONCLUSIONFor the infections after the lumbar posterior surgery,the elevated erythrocyte sedimentation rate or C-reactive protein can be served as an indicator before the bacterial culture.The poor health state and the low proficiency of surgical operation were the related risk factors,thus it is necessary to focus on the blood sedimentation and C-reactive protein,strengthen the nutrition to improve the immunity,shorten the time of surgical exposure to reduce the risk of being infected,use sensitive antibiotics,and perform focal debridement lavage drainage so as to improve the cure rate.