脊柱结核术后手术部位感染的相关危险因素分析

Analysis of related influencing factors of postoperative surgical infection in patients with spinal tuberculosis

目的:探讨脊柱结核术后手术部位感染的危险因素,总结预防策略并为临床治疗提供参考。方法:回顾性分析2018年1月~2020年1月于我院实施手术治疗的脊柱结核患者161例。其中男性101例,女性60例,年龄46.9±17.9岁。发生术后手术部位感染10例,感染发生率为6.21%。术后手术部位感染患者中男性5例,女性5例;病原学培养结果:金黄色葡萄球菌4例,铜绿假单胞菌3例,阴沟肠杆菌2例、鲍曼不动杆菌1例。记录患者相关因素信息包括:年龄是否>60岁、性别、血清白蛋白浓度是否<30g/L、血沉是否≥20mm/h、体质指数(body mass index,BMI)是否<18.5kg/m^2、患者是否患有糖尿病、术后72h峰值血糖值是否≥11.1mmol/L、患者是否有吸烟史、是否合并脊髓损伤、病灶部位(颈段、胸段、胸腰段或腰段)及范围(病灶范围是否<3个节段)、是否存在后凸畸形、患者是否存在寒性脓肿,手术相关因素包括:是否使用脉冲式冲洗枪、是否使用内固定、是否进行前柱重建、手术时间是否<300min、是否有术中输血、术中是否局部使用链霉素及手术入路为前入路或后入路等内容。采用SPSS 23.0软件进行统计分析,用非条件Logistic回归法进行多因素分析。结果:单因素分析结果显示,血清蛋白浓度<30g/L(感染率16.7%)、血沉≥20mm/h(感染率14.0%)、BMI<18.5kg/m^2(感染率16.7%)、患有糖尿病(感染率15.2%)、峰值血糖≥11.1mmol/L(感染率24%)、合并寒性脓肿(感染率3.0%)等患者相关因素是脊柱结核术后手术部位感染的危险因素(P<0.05),手术时间长(≥300min)(感染率12.7%)、术中进行了输血(感染率10.9%)、局部未使用链霉素(感染率15.8%)等手术相关因素是脊柱结核术后手术部位感染的危险因素(P<0.05),而年龄、性别、是否有吸烟史、是否合并脊髓损伤、病灶部位、范围、是否存在后凸畸形等患者相关因素不是脊柱结核术后手术部位感染的危险因素(P>0.05),是否使用脉冲式冲洗枪、是否使用内固定、是否进行前柱重建及手术入路为前入路或后入路等手术相关因素不是脊柱结核术后手术部位感染的危险因素(P>0.05)。多因素Logistic回归分析显示,血清蛋白浓度<30g/L、峰值血糖≥11.1mmol/L、合并寒性脓肿是脊柱结核术后手术部位感染的独立危险因素(P<0.05),术中局部使用链霉素作为一项保护因素,可有效预防脊柱结核术后手术部位感染。结论:脊柱结核术前应尽量调整患者营养状态,积极控制血糖,纠正低蛋白血症;术中链霉素对术区感染病灶的局部应用以及寒性脓肿病灶的彻底清除都可以有效降低患者术后手术部位感染的发生。

Objectives:To explore the risk factors of postoperative infection of spinal tuberculosis,summarize the preventive measures,and provide reference for clinical treatment.Methods:A retrospective analysis of risk factors was performed on 161 patients with spinal tuberculosis who received surgical treatment in our hospital from January 2018 to January 2020.Information related to patient factors was collected,including:Whether age>60,gender,serum albumin concentration<30g/L,blood sedimentation≥20mm/h,or BMI<18.5kg/m^2,diabetes,blood sugar levels>11.1mmol/L 72h after peak,and smoking history,spinal cord injury,lesion position(neck,chest,chest and waist section or lumbar segment)and scope(lesions was less than 3 segments),convex deformities,and cold abscess.Surgery related factors included:usage of pulsed rinsing gun,implants filled,anterior column reconstruction,operative time less than 300 minutes,intraoperative blood transfusion,local use of intraoperative streptomycin,and surgical approach.SPSS 23.0 software was used for statistical analysis,and non-conditional Logistic regression was used for multi-factor analysis.Results:Single factor analysis showed that low serum protein concentration(<30g/L)(rate 16.7%),blood sedimentation 20mm/h(infection rate 14.0%),or higher BMI<18.5kg/m^2(infection rate 16.7%),diabetes(infection rate 15.2%),peak blood sugar or greater tendency for 11.1mmol/L(infection rate 24%),merging,and cold abscess(infection rate 3.03%),and other related factors in patients with spinal tuberculosis were the risk factors for postoperative surgical site infection(P<0.05).Among surgical factors,long operation time(≥300min)(infection rate:12.7%),intraoperative blood transfusion(infection rate:10.9%),and local absence of streptomycin(infection rate:15.8%)were risk factors for postoperative surgical site infection of spinal tuberculosis(P<0.05).Age,sex,smoking history,spinal cord injury,lesion position and scope,or presence of kyphosis were not risk factors for surgical site infection(P>0.05).In addition,use of pulse washing gun,filled implants,anterior column reconstruction,and surgical approach were not risk factors either(P>0.05).Conclusions:Before spinal tuberculosis,the nutritional status of the patients should be adjusted as much as possible,and the blood glucose should be actively controlled.The application of streptomycin to the infected lesions in the operative area and the thorough removal of cold abscess lesions should be regarded as the key points for the prevention of postoperative infection in these patients.