临床和病原诊断胸腰椎体手术后感染患者的临床特征分析

Characteristics of patients clinically or etiologically diagnosed with infections after thoracolumbar vertebrae surgery

目的探究临床和病原诊断胸腰椎体手术后感染患者的特点。方法选取2015年7月-2016年7月于医院骨科接受治疗的胸腰椎体手术患者146例,按照随机数表法分为A、B两组,每组73例;A组采用临床诊断方式诊断患者是否存在感染,B组采用病原诊断方式诊断患者是否存在感染;收集两组患者资料以及B组病原培养出的感染细菌类型资料,比较A、B两组的感染临床表现以及感染发生时间、感染深度,同时比较两组患者的白细胞以及中性粒细胞的数量和感染患者体温情况。结果 B组患者病原诊断中培养的病原菌共102种,单一细菌感染患者55例占75.3%,多细菌感染患者18例占24.7%,所有细菌中金黄色葡萄球菌占总感染细菌最多,为37株占36.3%;A组患者诊断出深层感染20例占27.4%,B组患者诊断出深层感染34例占46.6%,差异有统计学意义(P<0.05);A组患者有切口渗液现象22例占30.1%,B组患者有切口渗液现象54例占74.0%,差异有统计学意义(P<0.05);A组患者白细胞数量(9.23±3.53)×109/L,体温(37.34±1.04)℃,中性粒细胞(70.72±10.57)%;B组患者白细胞数量(11.45±5.18)×109/L,体温(38.13±1.10)℃,中性粒细胞(78.36±14.54)%,差异均有统计学意义(P<0.05)。结论患者胸腰椎体术后感染的临床表现以手术切口渗液、局部开裂和体温升高为主。在临床与病原学这两种诊断方式中,病原诊断较为细致确切但较为困难,临床诊断较为容易但易误诊。

OBJECTIVE To explore the characteristics of patients who were clinically or etiologically diagnosed with infections after thoracolumbar vertebrae surgery.METHODS A total of 146 patients who received thoracolumbar vertebrae surgery in department of orthopedics from Jul 2015 to Jul 2016 were enrolled in the study and randomly divided into the group A and the group B,with 73 cases in each group.The gourp A was treated with clinical diagnosis,while the group B was treated with etiological diagnosis.The data of the two groups of patients and the data of species of pathogens cultured from the group B were collected.The clinical manifestations of infection,time of occurrence of infections,and infections depth were compared between the group A and the group B;the white blood cell counts,neutrophils counts,and body temperature were observed and compared between the two groups of patients.RESULTS Totally 102 species of pathogens were cultured from the group B,55（75.3%）patients has single bacterial infections,18（24.7%）had multiple bacterial infections,and 37（36.3%）patients had Staphylococcus aureus infections.Totally 20（27.4%）patients were diagnosed with deep infections in the group A,34（46.6%）patients were diagnosed with deep infections in the group B,and there was significant difference（P〈0.05）.Totally 22（30.1%）patients had incision exudates in the group A,54（74.0%）patients had incision exudates in the group B,and there was significant difference（P〈0.05）.The white blood cell counts were（9.23±3.53）×10^9/L in the group A,（11.45±5.18）×10^9/L in the group B;the body temperature was（37.34±1.04）℃ in the group A,（38.13±1.10）℃ in the group B;the neutrophils counts were（70.72±10.57）%in the group A,（78.36±14.54）% in the group B,and there was significant difference（P〈0.05）.CONCLUSIONThe surgical incision exudates,local cracking,and rise of body temperature are the major clinical manifestations of the thoracolumbar vertebrae surgery patients with postoperative infections.As compared with the two clinical diagnosis approaches,the etiological diagnosis is precise but difficult,and the clinical diagnosis is simple but misdiagnosed.