脊柱手术术后感染的病原菌和药敏分析及血清炎症因子的辅助诊断价值

Distribution and drug susceptibility of pathogens causing postoperative infections in spinal surgery patients and value of serum inflammatory cytokines in auxiliary diagnosis

目的探讨脊柱手术术后感染的病原菌及血清炎症因子改变的意义,以期为临床诊疗提供参考。方法分析2012年1月-2015年1月在医院接受脊柱后路术且术后并发感染的32例患者的临床资料(感染组),选择同期收治的40例未感染手术患者为未感染组,另纳入40例健康体检者为对照组,分析感染组病原菌分布及三组外周血细胞因子的差异。结果感染组32例患者共分离致病菌41株,其中革兰阴性菌23株占56.10%,革兰阳性菌18株占43.90%;感染组患者术后住院时间显著长于未感染组,差异有统计学意义(19.2±3.1 VS 25.1±4.9,P<0.05);感染组患者外周血IL-6及PCT水平显著高于未感染组(P<0.05);ROC曲线分析结果:以24.09ng/L为截点值,IL-6预测患者术后感染的敏感性为84.38%,特异性为85.00%,曲线下面积为0.89,优于PCT。结论脊柱手术术后感染的病原菌以大肠埃希菌及金黄色葡萄球菌为主,感染可显著延长患者术后住院时间并导致外周血IL-6及PCT升高,其中IL-6对感染发生有一定预测价值。

OBJECTIVE To explore the pathogens causing postoperative infections in patients undergoing spinal sur- gery and analyze the significance of change of serum inflammatory cytokines so as to provide guidance for clinical diagnosis and treatment. METHODS Totally 32 patients who underwent the spinal posterior surgery in hospitals from Jan 2012 to Jan 2015 and had postoperative infections were chosen as the infection group, the clinical data of the patients were analyzed, meanwhile, 40 patients who received the surgery but did not have infections were set as the non-infection group, and 40 healthy people who received physical examination were chosen as the control group. The distribution of pathogens isolated from the patients with infections was analyzed, and the levels of pe- ripheral blood cytokines were observed and compared among the three groups. RESULTS A total of 41 strains of pathogens were isolated from the 32 patients with infections, including 23 （56.10%） strains of gram-negative bac- teria and 18 （43.90 %） strains of gram-positive bacteria. The postoperative length of hospital stay of the infection group was （25.1±4. 9）, significantly longer than （19.2±3.1） of the non-infection group （P〈0.05）. The levels of peripheral blood IL-6 and PCT of the infection group were significantly higher than those of the non-infection group （P〈0. 05）. The result of ROC curve analysis showed that with 24.09 ng/L set as the cutoff value, the sen- sitivity of IL-6 was 84.38% in prediction of the postoperative infections, the specificity 85.00%, the area under curve 0. 89; it was superior to PCT. CONCLUSION Escherichia coli and Staphylococcus aureus are dominant among the pathogens causing the postoperative infections in the patients undergoing spinal surgery. The infections may remarkably extend the postoperative length of hospital stay and lead to the elevation of peripheral blood IL-6 and PCT levels, and the IL-6 has certain value in prediction of the infections.