目的探讨脊柱手术围手术期心血管并发症的发生率和危险因素。方法选择2015年1月~2020年12月在该院接受全身麻醉下脊柱手术的1508例患者作为研究对象,记录患者性别、年龄、体质量指数(body mass index,BMI)、美国麻醉医师协会(American s...目的探讨脊柱手术围手术期心血管并发症的发生率和危险因素。方法选择2015年1月~2020年12月在该院接受全身麻醉下脊柱手术的1508例患者作为研究对象,记录患者性别、年龄、体质量指数(body mass index,BMI)、美国麻醉医师协会(American society of anesthesiologists,ASA)分级、血红蛋白(haemoglobin,Hb)、内生肌酐清除率(endogenous creatinine clearance rate,Ccr)、伴随疾病、手术原因、手术状态、手术方式、融合节段、术中事件、手术医师等等资料,观察围手术期(本研究定义为患者住院期间及术后28 d内)发生的主要心血管不良事件(major adverse cardiovascular events,MACE)发生率。根据是否发生MACE将患者分为两组,采用单因素(卡方检验、t检验)和多因素分析观察影响MACE的风险因素。结果本研究中,共22例患者在研究定义的时间内发生MACE,发生率1.46%。单因素分析显示,MACE和非MACE患者的BMI、Hb、高血压、中风、阻塞性睡眠呼吸暂停、甲状腺疾病、慢性肺疾病、手术状态、手术方式、术中高血压等资料比较,差异均无统计学意义(P>0.05);MACE和非MACE患者的性别、年龄、ASA分级、Ccr、糖尿病、慢性肾脏疾病、慢性心力衰竭、手术原因、融合节段、术中低血压、术中输血等资料比较,差异均存在统计学意义(P<0.05)。多因素Logistic分析结果显示,手术原因为脊柱侧凸、术前有慢性心力衰竭史、术中发生低血压均是影响术后MACE的风险因素(P<0.05)。结论脊柱手术患者围手术期MACE发生率为1.45%,影响MACE发生的风险因素可能包括术前慢性心力衰竭史、脊柱侧凸手术和术中低血压。展开更多
目的:通过查阅预防性使用万古霉素粉末手术比较的文献,对该方法在脊柱手术后降低感染率的效果做出系统评价,为以后的临床工作提供依据。方法:通过Pubmed,Medline,Elseveir,万方,CNKI等数据库,以“vancomycin”,“local/intraoperative/t...目的:通过查阅预防性使用万古霉素粉末手术比较的文献,对该方法在脊柱手术后降低感染率的效果做出系统评价,为以后的临床工作提供依据。方法:通过Pubmed,Medline,Elseveir,万方,CNKI等数据库,以“vancomycin”,“local/intraoperative/topical/intra-wound”,“spine/spinal/lumbar/cervical/thoracolumbar surgery”,“infection”,“SSI”,“脊柱”,“腰椎”,“颈椎”,“手术”,“万古霉素”,“感染”等关键词查找相关术中预防性应用万古霉素粉末对术后感染发生率影响方面的病例对照研究论文,并利用Revman5.3荟萃分析软件比较文献中总体感染率,并按不同亚组分析是否应用万古霉素对不同部位、不同类型的脊柱手术的感染率的影响。结果:共查出论文1713篇,其中病例对照试验有38篇,最后筛选出符合要求的文献25篇;有25个研究比较了预防性使用万古霉素粉末对脊柱手术后感染率的影响。总病例16,688例,其中预防性使用万古霉素组7048例,对照组9640例。其荟萃分析结果提示术中预防性使用万古霉素粉末后术后出现感染的可能性为不使用万古霉素时的0.38倍,二者之间的差异有显著性(P Objective: To systematically evaluate the effect of this method in reducing the infection rate after spinal surgery by reviewing the comparative literature of prophylactic vancomycin powder surgery, so as to provide a basis for future clinical work. Methods: Pubmed, Medline, Elseveir, Wanfang, CNKI and other databases, with the following methods: “vancomycin”, “local/intraoperative/topical/intra-wound”, “spine/spinal/lumbar/cervical/thoracolumbar surgery”, “infection”, “SSI”, “spine”, “lumbar spine”, “cervical spine”, “surgery”, “vancomycin”, “infection” and other keywords were used to find case-control research papers on the effect of intraoperative prophylactic vancomycin powder on the incidence of postoperative infection, and the Revman5.3 meta-analysis software was used to compare the overall infection rate in the literature, and the effect of vancomycin application on the infection rate of different parts and different types of spine surgery was analyzed according to different subgroups. Results: A total of 1713 papers were identified, including 38 case-control trials, and 25 papers were screened to meet the requirements. Twenty-five studies compared the effect of prophylactic use of vancomycin powder on infection rates after spinal surgery. The total number of cases was 16,688, including 7048 cases in the prophylactic vancomycin group and 9640 cases in the control group. The results of meta-analysis showed that the probability of postoperative infection after intraoperative prophylactic use of vancomycin powder was 0.38 times higher than that of vancomycin without vancomycin, and the difference between the two was significant (P < 0.01). At the same time, the incidence of infection after vancomycin was 0.28 times higher (0.17, 0.45) than that of vancomycin in patients treated with internal fixation (P < 0.01). However, vancomycin utilization in patients without internal fixation had no significant effect on postoperative infection (P = 0.61). Conclusion: The local prophylactic use of vancomycin powder in spine surgery can significantly reduce the incidence of postoperative infection, and this effect is more obvious in patients with internal fixation, which can be popularized and applied in clinical practice of spine surgery.展开更多
文摘目的探讨脊柱手术围手术期心血管并发症的发生率和危险因素。方法选择2015年1月~2020年12月在该院接受全身麻醉下脊柱手术的1508例患者作为研究对象,记录患者性别、年龄、体质量指数(body mass index,BMI)、美国麻醉医师协会(American society of anesthesiologists,ASA)分级、血红蛋白(haemoglobin,Hb)、内生肌酐清除率(endogenous creatinine clearance rate,Ccr)、伴随疾病、手术原因、手术状态、手术方式、融合节段、术中事件、手术医师等等资料,观察围手术期(本研究定义为患者住院期间及术后28 d内)发生的主要心血管不良事件(major adverse cardiovascular events,MACE)发生率。根据是否发生MACE将患者分为两组,采用单因素(卡方检验、t检验)和多因素分析观察影响MACE的风险因素。结果本研究中,共22例患者在研究定义的时间内发生MACE,发生率1.46%。单因素分析显示,MACE和非MACE患者的BMI、Hb、高血压、中风、阻塞性睡眠呼吸暂停、甲状腺疾病、慢性肺疾病、手术状态、手术方式、术中高血压等资料比较,差异均无统计学意义(P>0.05);MACE和非MACE患者的性别、年龄、ASA分级、Ccr、糖尿病、慢性肾脏疾病、慢性心力衰竭、手术原因、融合节段、术中低血压、术中输血等资料比较,差异均存在统计学意义(P<0.05)。多因素Logistic分析结果显示,手术原因为脊柱侧凸、术前有慢性心力衰竭史、术中发生低血压均是影响术后MACE的风险因素(P<0.05)。结论脊柱手术患者围手术期MACE发生率为1.45%,影响MACE发生的风险因素可能包括术前慢性心力衰竭史、脊柱侧凸手术和术中低血压。
文摘目的:通过查阅预防性使用万古霉素粉末手术比较的文献,对该方法在脊柱手术后降低感染率的效果做出系统评价,为以后的临床工作提供依据。方法:通过Pubmed,Medline,Elseveir,万方,CNKI等数据库,以“vancomycin”,“local/intraoperative/topical/intra-wound”,“spine/spinal/lumbar/cervical/thoracolumbar surgery”,“infection”,“SSI”,“脊柱”,“腰椎”,“颈椎”,“手术”,“万古霉素”,“感染”等关键词查找相关术中预防性应用万古霉素粉末对术后感染发生率影响方面的病例对照研究论文,并利用Revman5.3荟萃分析软件比较文献中总体感染率,并按不同亚组分析是否应用万古霉素对不同部位、不同类型的脊柱手术的感染率的影响。结果:共查出论文1713篇,其中病例对照试验有38篇,最后筛选出符合要求的文献25篇;有25个研究比较了预防性使用万古霉素粉末对脊柱手术后感染率的影响。总病例16,688例,其中预防性使用万古霉素组7048例,对照组9640例。其荟萃分析结果提示术中预防性使用万古霉素粉末后术后出现感染的可能性为不使用万古霉素时的0.38倍,二者之间的差异有显著性(P Objective: To systematically evaluate the effect of this method in reducing the infection rate after spinal surgery by reviewing the comparative literature of prophylactic vancomycin powder surgery, so as to provide a basis for future clinical work. Methods: Pubmed, Medline, Elseveir, Wanfang, CNKI and other databases, with the following methods: “vancomycin”, “local/intraoperative/topical/intra-wound”, “spine/spinal/lumbar/cervical/thoracolumbar surgery”, “infection”, “SSI”, “spine”, “lumbar spine”, “cervical spine”, “surgery”, “vancomycin”, “infection” and other keywords were used to find case-control research papers on the effect of intraoperative prophylactic vancomycin powder on the incidence of postoperative infection, and the Revman5.3 meta-analysis software was used to compare the overall infection rate in the literature, and the effect of vancomycin application on the infection rate of different parts and different types of spine surgery was analyzed according to different subgroups. Results: A total of 1713 papers were identified, including 38 case-control trials, and 25 papers were screened to meet the requirements. Twenty-five studies compared the effect of prophylactic use of vancomycin powder on infection rates after spinal surgery. The total number of cases was 16,688, including 7048 cases in the prophylactic vancomycin group and 9640 cases in the control group. The results of meta-analysis showed that the probability of postoperative infection after intraoperative prophylactic use of vancomycin powder was 0.38 times higher than that of vancomycin without vancomycin, and the difference between the two was significant (P < 0.01). At the same time, the incidence of infection after vancomycin was 0.28 times higher (0.17, 0.45) than that of vancomycin in patients treated with internal fixation (P < 0.01). However, vancomycin utilization in patients without internal fixation had no significant effect on postoperative infection (P = 0.61). Conclusion: The local prophylactic use of vancomycin powder in spine surgery can significantly reduce the incidence of postoperative infection, and this effect is more obvious in patients with internal fixation, which can be popularized and applied in clinical practice of spine surgery.
