腰椎后路融合术后手术部位感染的相关危险因素分析

Risk factors of surgical site infection after posterior lumbar interbody fusion

目的分析腰椎后路融合术后手术部位感染(surgical site infection,SSI)的危险因素。方法收集我院2014年1月至2018年10月实施后路腰椎椎间融合术的324例患者资料,根据是否发生SSI分为SSI组与非SSI组,对两组患者的年龄、体质量指数(body mass index,BMI)、术区皮下脂肪和椎旁肌厚度、吸烟、饮酒、糖尿病、美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级、血液学资料、手术时间、手术节段、术后引流、脑脊液漏(cerebrospinal fluid leakage,CSFL)等资料进行单因素分析,然后对差异有统计学意义(P<0.05)的因素进行多因素Logistic分析以确定SSI的独立危险因素。结果本组324例中,14例发生 SSI,发生率为4.32%。单因素分析显示BMI、术区皮下脂肪厚度、术前ASA分级≥Ⅲ级、术前血清白蛋白浓度、术后血红蛋白浓度、手术时间、手术节段数、术后引流量、引流时间、CSFL与SSI相关。多因素Logistic回归分析显示术区皮下脂肪厚度、术前血清白蛋白浓度、术后引流时间是发生SSI的独立危险因素(P<0.05)。结论术区皮下脂肪厚度较厚、术前血清白蛋白水平较低、术后引流时间较长的患者腰椎后路融合术后发生SSI的风险较高,应采取针对性的措施以降低SSI的发生率。

Objective To analyze the risk factors of surgical site infection(SSI)after posterior lumbar fusion.Methods Between January 2014 and October 2018,324 patients after posterior lumbar interbody fusion were enrolled in this study,and all were divided into the SSI group and the non-SSI group.The age,body mass index(BMI),thickness of subcutaneous fat and paraspinal muscles,smoking,drinking,diabetes,American Society of Anesthesiologists(ASA)grading,hematology,operation time,operation segment,postoperative drainage,cerebrospinal fluid leakage(CSFL)and other data were analyzed by univariate analysis.Statistically significant factors(P<0.05)were analyzed by multivariate logistic analysis to determine the independence of SSI risk factors.Results Among 324 patients,SSI occurred in 14 patients(4.32%).Univariate analysis showed that SSI was significantly correlated with BMI,subcutaneous fat thickness,preoperative ASA grading≥Ⅲ,postoperative hemoglobin,preoperative serum albumin,operation time,operation segment,postoperative drainage,draining time and CSFL.Multivariate logistic regression analysis showed that subcutaneous fat thickness,preoperative serum albumin concentration and postoperative drainage time were independent risk factors of SSI(P<0.05).Conclusions Patients with thick subcutaneous fat,low preoperative serum albumin level and long postoperative drainage time have a higher risk of surgical site infection after posterior lumbar fusion,so that targeted measures should be taken to reduce the incidence of surgical site infection.