胸腰椎后路术后深部手术切口感染的危险因素分析

摘要

Objective To study the risk factors for deep surgical site infection after posterior thoracic and lumbar surgery.Methods The medical data of the patients with deep surgical site infection after posterior thoracic and lumbar surgery from January 2008 to December 2013 were reviewed.For each case patient,3 non-infected controls were randomly selected from the same database of all patients who underwent posterior thoracic and lumbar surgery.Patients who had diagnosis of spinal fractures,infection,tuberculosis,and tumor were excluded.The microbiology and related factors were collected and analyzed.T-test,x2 test and Logistic analysis were used to analyze the data,respectively.Results Ninety-nine cases were identified(infection group),57 men and 42 women,average 54.5 years old,average body mass index 26.4 kg/m2.Fifty-five(55.6％) patients were identified with organisms,and the most common identified organism was Staphylococcus Aureus.Compared with the cases in the control group(44.4 g/L),the cases in the infection group (43.1 g/L) had a significant low albumin preoperatively (P =0.001).Multivariate Logistic analysis showed that obesity (OR =2.102,95 ％ CI =1.259-3.508),diabetes (OR =1.926,95 ％CI =1.041-3.563),number of surgical levels ≥ 3 (OR =1.985,95％ CI =1.130-3.486) were risk factors for this complication (P ＜ 0.05).Conclusion For deep surgical site infection after posterior thoracic and lumbar surgery,obesity,diabetes,preoperative low albumin and number of surgical levels ≥ 3 are risk factors.%目的 探讨胸腰椎后路术后患者深部手术切口感染的危险因素.方法 回顾性分析北京大学第三医院2008年1月至2013年12月收治的接受胸腰椎后路手术治疗的患者资料.将术后发生深部手术切口感染的99例患者分入感染组,并按照1∶3的比例随机抽取同期术后未发生手术切口感染的297例患者纳入对照组.排除胸腰椎新鲜骨折、感染、结核、肿瘤患者,记录并分析患者的一般观察指标及围手术期相关指标.分别采用t检验和x2检验对计量资料和计数资料进行分析.危险因素的评估和检测采用单因素和多因素Logistic回归分析.结果 感染组99例患者中男性57例,女性42例;初次手术时平均年龄54.5岁;平均体重指数26.4 kg/m2.微生物学检查结果显示,55.6％(55/99)的感染患者细菌培养阳性,其中金黄色葡萄球菌是主要的病原菌(58.2％),12.1％(12/99)为混合感染.感染组术前白蛋白平均为43.1 g/L,与对照组(44.4 g/L)相比,差异有统计学意义(P=0.001).多因素Logistic回归分析结果显示,肥胖(OR=2.102,95％ CI=1.259～3.508)、糖尿病(OR=1.926,95％ CI=1.041 ～3.563)、手术节段数≥3节(OR=1.985,95％ CI=1.130～3.486)对胸腰椎后路术后并发深部手术切口感染有影响(P＜0.05).结论 肥胖、糖尿病、术前白蛋白低、手术节段数≥3节是胸腰椎后路术后深部手术切口感染的危险因素.