脊柱后路术后伤口愈合不良相关影响因素研究

Influencing factors of poor wound healing after posterior spinal surgery

目的:探讨脊柱后路术后伤口愈合不良的相关影响因素。方法:选取60例脊柱后路术后伤口愈合不良患者愈合不良组,同期80例脊柱后路术后伤口愈合良好患者为愈合良好组。比较两组患者临床资料,通过Logistic回归模型分析伤口愈合不良的影响因素。结果:两组患者性别、体重指数(BMI)、吸烟史、饮酒史、手术原因、手术月份、术中失血量、术后引流时间与导尿时间比较,差异无统计学意义(P>0.05);愈合不良组年龄、糖尿病占比高于愈合良好组(P<0.05),经验性使用抗菌药患者占比低于愈合良好组(P<0.05),手术时间长于愈合良好组(P<0.05)。两组患者手术前后血红蛋白(HGB)、术前白蛋白(Alb)含量比较,差异无统计学意义(P>0.05);愈合不良组术后Alb<35 g/L患者占比高于愈合良好组(P<0.05)。Logistic回归分析显示,年龄、糖尿病、手术时间、未经验性使用抗菌药、术后Alb<35 g/L为伤口愈合不良的独立危险因素(P<0.05)。结论:脊柱后路术后伤口愈合不良的危险因素主要为年龄、糖尿病、手术时间、未经验性使用抗菌药及术后低蛋白血症等,临床应据此采取针对性防治措施,以降低伤口愈合不良风险。

Objective:To analyze the influencing factors of poor wound healing after posterior spinal surgery.Methods:A total of 60 patients with poor wound healing after posterior spinal surgery in the hospital were enrolled as poor healing group,while other 80 patients with good wound healing during the same period were enrolled as good healing group.The clinical data between the two groups were compared.Logistic regression model was constructed to analyze the influencing factors of poor wound healing.Results:There was no significant difference between the two groups in gender,body mass index(BMI),smoking history,drinking history,operation reasons,operation month,intraoperative blood loss,postoperative drainage time and catheterization time(P>0.05).The age and proportion of cases with diabetes mellitus in poor healing group were significantly higher than those in good healing group(P<0.05),proportion of cases with empirical usage of antibiotics was significantly lower than that in good healing group(P<0.05),and operation time was significantly longer than that in good healing group(P<0.05).There was no significant difference in hemoglobin(HGB)before and after surgery or preoperative albumin(Alb)between the two groups(P>0.05).The proportion of cases with postoperative Alb<35 g/L in poor healing group was significantly higher than that in good healing group(P<0.05).Logistic regression analysis showed that age,diabetes mellitus,operation time,no empirical usage of antibiotics and postoperative Alb<35 g/L were independent risk factors of poor wound healing(P<0.05).Conclusion:The main risk factors of poor wound healing after posterior spinal surgery include age,diabetes mellitus,operation time,no empirical usage of antibiotics and postoperative hypoproteinemia.Clinically,targeted measures can be taken based on these factors to reduce the risk of poor wounds healing.