脊柱后路术后深部感染应用持续闭式冲洗引流术对炎性应激状态的影响研究

Influence of continuous closed irrigation and drainage on inflammatory stress state of posterior spinal surgery patients with postoperative deep infections

目的探讨持续闭式冲洗引流术对脊柱后路手术后感染患者的应用效果,研究对炎性应激状态的影响。方法选取2012年1月-2015年12月在医院行脊柱后路手术感染患者60例,随机分为试验组和对照组,每组各30例;患者清除感染组织后,试验组放置持续闭式冲洗引流系统,对照组采用凡士林纱布覆盖创面,给予敏感的抗菌药物;于治疗前、治疗后1、3、5周4个时间点抽血化验,测定血降钙素原(PCT)、C-反应蛋白(CRP)、血沉(ESR)、白介素6(IL-6)及肿瘤坏死因子α(TNF-α)表达水平。结果试验组的伤口治愈率为90.00%,显著高于对照组的63.33%,试验组伤口的平均愈合时间(18.46±3.24)d,显著低于对照组的(23.45±5.93)d,差异有统计学意义(P<0.05);与治疗前相比,治疗后1、3、5周两组患者PCT、CRP、TNF-α、IL-6、ESR表达水平及白细胞数均显著降低(P<0.05),术后5周两组患者上述指标均恢复至正常;与对照组患者相比,治疗后1、3周两个时间点试验组患者PCT、CRP、TNF-α、IL-6、ESR表达水平及白细胞数均显著降低(P<0.05)。结论与传统的保守治疗相比,持续闭式冲洗引流术对脊柱后路手术能够更快更好地控制术后感染,减轻机体炎性应激状态。

OBJECTIVE To explore the effect of continuous closed irrigation and drainage on posterior spinal surgery patients with postoperative infection and observe the influence on inflammatory stress state.METHODS From Jan 2012 to Dec,2015,a total of 60 patients who underwent the posterior spinal surgery and were complicated with postoperative infection were enrolled in the study and randomly divided into the experimental group and the control group,with 30 cases in each group.After the infected tissues were removed,the experimental group was placed with continuous closed irrigation and drainage system,the control group was treated with covering wounds with Vaseline gauze and was given sensitive antibiotics.The blood tests were carried out before the treatment and after the treatment for 1,3,and 5weeks so as to determine the levels of procalcitonin（PCT）,C-reactive protein（CRP）,erythrocyte sedimentation rate（ESR）,interleukin 6（IL-6）,and tumor necrosis factorα（TNF-α）.RESULTS The wound healing rate of the experimental group was 90.00%,significant higher than 63.33% of the control group.The average wound healing time of the experimental group was（18.46±3.24）days,significantly shorter than（23.45±5.93）days of the control group（P〈0.05）.The levels of PCT,CRP,TNF-α,IL-6,and ESR as well as white blood cell counts were remarkably reduced after the treatment for 1,3,and 5weeks（P〈0.05）.The above indexes of the two groups of patients returned to normal after the surgery for 5weeks.The levels of PCT,CRP,TNF-α,IL-6,and ESR as well as white blood cell counts were significantly lower in the experimental group than in the control group after the treatment for 1,3weeks（P〈0.05）.CONCLUSIONAs compared with the traditional conservative therapy,the continuous closed irrigation and drainage can achieve more significant effect on control of the postoperative infection in the patients undergoing the posterior spinal surgery and reduce the body inflammatory stress state.