腰椎滑脱症术后伤口感染危险因素分析

Analysis of risk factors of postoperative wound infection in lumbar spondylolisthesis

目的:探讨腰椎滑脱症术后伤口感染发生的相关危险因素。方法:对2013年1月至2017年12月因腰椎滑脱症行后路减压融合内固定术的296例患者进行回顾性分析,根据术后伤口是否感染分为感染组29例,男13例,女16例,平均年龄(67.03±1.01)岁;非感染组267例,男91例,女176例,平均年龄(52.32±16.08)岁。记录两组患者的性别、年龄、肥胖体重指数(BMI)、吸烟史、糖尿病史、激素药物使用史、白蛋白水平、手术时间、美国麻醉医师协会评分(ASA评分)、围手术期输血、引流管时间等,对单因素Logistic回归分析有统计学意义的危险因素进行多元Logistic回归分析,同时采用SPSS决策树模型确定连续性变量的分层界点,进一步明确独立危险因素。结果:296例患者中术后共有29例发生手术切口感染,发生率约9.8%(29/296)。感染组与非感染组在BMI、年龄、糖尿病史、引流管时间、激素药物使用史、白蛋白水平、手术时间差异有统计学意义(P<0.05);单因素Logistic回归分析排除各因素间的相互影响后结果显示:肥胖、年龄、糖尿病史、激素药物使用史、手术时间、引流管时间可能为腰椎滑脱症术后伤口感染的危险因素,将上述可能的危险因素纳入多因素Logistic回归分析显示:年龄、糖尿病史、激素药物使用史、引流管时间是术后伤口感染的独立危险因素。结论:年龄、糖尿病史、激素药物使用史、引流管时间是术后伤口感染的独立危险因素,年龄≥64岁、引流管留置时间超过48 h、合并糖尿病、激素药物使用是术后发生伤口感染的高危因素。

Objective:To explore related risk factors of postoperative wound infection in lumbar spondylolisthesis.Methods:The clinical data of 296 patients with lumbar spondylolisthesis underwent posterior decompression and fusion from January 2013 to December 2017 were retrospectively analyzed.According to whether the wound was infected or not,the patients were divided into infection group and non-infection group.There were 29 patients in infection group including 13 males and 16 females with an average age of(67.03±1.01)years old and 267 patients in non-infection group including 91 males and 176 females with an average age of(52.32±16.08)years old.Gender,age,body mass index(BMI),smoking history,diabetes history,hormone use history,albumin level,operation time,ASA score,perioperative blood transfusion and drainage time were recorded.The multivariate Logistic regression analysis was carried out if univariate Logistic regression analysis of risk factors were statistical significant.At the same time the SPSS decision tree model was used to determine the stratified points of the continuous variables to further specify the independent risk factors.Results:Postoperative wound infection occurred in 29 cases among all patients,with the incidence rate of 9.8%(29/296).There were significant differences in BMI,age,diabetes history,drainage time,hormone use history,albumin level and operation time between two groups(P<0.05).After excluding mutual infection among these factors by univariate Logistic regression analysis,results showed obesity,age,diabetes history hormone use history operation time,drainage time may be risk factors for wound infection after lumbar spondylolisthesis surgery.By multivariate Logistic regression analysis of possible risk factors,results showed age,diabetes history,hormone use history and drainage time were independent risk factors for wound infection after operation.Conclusion:Age,diabetes history,hormone use history and drainage time are independent risk factors for postoperative wound infection.Age more than or equal to 64 years old,drainage tube retention time more than 48 h,complicated with diabetes mellitus and hormone use are high risk factors for postoperative wound infection.