万古霉素联合头孢呋辛加局部庆大霉素浸渍胶原海绵预防脊柱手术感染

Vancomycin combined with cefuroxime plus local gentamicin impregnated with collagen sponge in the prevention of spinal surgery

目的探讨万古霉素联合头孢呋辛加局部庆大霉素浸渍胶原海绵预防脊柱手术感染的应用价值。方法将398例脊柱手术患者根据预防感染方法分为对照组(198例)和观察组(200例)。对照组关闭切口前置入庆大霉素浸渍胶原海绵,观察组给予万古霉素联合头孢呋辛加局部置入庆大霉素浸渍胶原海绵。比较两组患者手术部位感染情况,并采用单因素和多因素分析手术部位感染的危险因素。结果手术部位感染发生率观察组为0.5%,显著低于对照组的5.1%(P<0.05)。单因素分析结果显示,是否采用万古霉素联合头孢呋辛加局部庆大霉素浸渍胶原海绵、年龄、BMI、手术时间以及是否合并糖尿病是影响术后感染的危险因素。Logistic多因素回归分析结果显示,是否采用万古霉素联合头孢呋辛加局部庆大霉素浸渍胶原海绵以及手术时间是影响术后感染的重要因素。结论万古霉素联合头孢呋辛加局部庆大霉素浸渍胶原海绵能够显著降低脊柱SSI发生率。

Objective To investigate clinical application value of vancomycin combined with cefuroxime plus local gentamicin impregnated with collagen sponge in the prevention of spinal surgery. Methods The 398 cases of patients undergoing spinal surgery were divided into control group（ 198 cases） and observation group（ 200 cases）. The control group was implanted with gentamicin impregnated collagen sponge before closure incision in the surgery,and the observation group was treated with vancomycin combined with cefuroxime plus local gentamicin impregnated with collagen sponge during the surgery. The surgical site infection（ SSI） was compared between the two groups,and the risk factors of SSI were analyzed by single factor and multivariate analysis. Results The incidence rate of SSI（ 0. 5%）in the observation group was lower than that of 5. 1% in the control group（ P〈0.05）. Single factor analysis showed that the use of vancomycin combined with cefuroxime plus local gentamicin impregnated with collagen sponge,age,BMI,operation time and diabetes mellitus were risk factors of SSI. It was shown that vancomycin combined with cefuroxime plus local gentamicin impregnated with collagen sponge and operation time were important factors of SSI by logistic multivariate regression analysis. Conclusions Vancomycin combined with cefuroxime plus local gentamicin impregnated with collagen sponge can significantly reduce the risk of spinal SSI.