北部战区总医院不同部位骨科Ⅰ类切口术后感染的临床与用药分析

Clinical situation and medication therapy analysis of postoperative infections in different sites of type I incision of orthopedic surgery in General Hospital of Northern Theater Command of PLA

目的分析可能影响2016年10月—2018年10月北部战区总医院935例行骨科Ⅰ类切口手术的住院患者术后炎症发生率的因素;回顾不同术区选择抗菌药物的种类及应用疗程,为临床个体化使用抗菌药物提供参考。方法使用Excel 2010及SPSS 20.0软件对所选取的研究对象进行统计,分析。结果脊柱与髋部的发病人群年龄晚于其他部位;上肢、腿部、足踝等部位男性发病年龄较早。脊柱组炎症发生率(41.08%)高于周边组(15.50%);伴与不伴发糖尿病,脊柱组患者术后炎症发生率无差别;但糖尿病可能提高周边组术后炎症发生率。使用抗生素骨水泥可降低脊柱组炎症发生率,但可能不会降低周边组术后炎症发生率。骨科手术围术期抗菌药物使用以二代头孢菌素(头孢呋辛、头孢美唑)为主(70%),其次为万古霉素;其他抗菌药物的使用占比相对较小。总体应用抗菌药物疗程平均5.04 d;脊柱组应用抗生素疗程最长(7.20 d),上肢组疗程最短(2.92 d);其他部位为髋部组(3.87 d),腿部组(3.51 d),足踝部组(3.09 d)。结论骨科不同部位Ⅰ类切口的患者在发病年龄、炎症发生率、抗生素选择及应用疗程方面存在明显差异,针对性地使用抗菌药物可促进骨科Ⅰ类切口手术患者个体化用药的合理性。

Objective To analyze the influence factors of post-operative inflammation of type I incision in orthopedic department from October 2016 to October 2018 in General Hospital of Northern Theater Command of PLA. The selection of antibacterial agents in different operative areas and the course of their application were retrospectively analyzed to provide suggestions for individual clinical use of antibacterial agents. Methods The selected research objects were counted and analyzed by Excel 2010 and SPSS 20.0 software.Results The incidence of spine and hip is later than other parts of the population. Upper limbs, legs, ankles and other parts of the male onset age earlier. The incidence of spinal inflammation(41.08%) was higher than that of the peripheral group(15.50%). There was no difference in postoperative inflammatory response rate between patients with and without diabetes. However, diabetes may increase postoperative inflammatory response rate in peripheral groups. Antibiotic bone cement can reduce inflammation rate in the spinal group, but may not reduce postoperative inflammation rate in the peripheral group. Second generation cephalosporin(cefuroxime,cefmetazole) was the main antibiotic used in perioperative period of orthopedic surgery(70%), followed by vancomycin. The use of other antimicrobials is relatively small. The average course of antibiotic application was 5.04 days. The course of antibiotics was longest in the spine group(7.20 days), and shortest in the upper limbs group(2.92 days). The other parts were the hip group(3.87 days),the leg group(3.51 days) and the ankle group(3.09 days). Conclusion The incidence of inflammation varies from site to site, and the efficacy of drugs varies from site to site. So, the rationality of drug use of the patients of type I incision of orthopedic could be promoted by the targeted application of antibacterial agents.