摘要
目的:探讨局部应用万古霉素预防腰椎手术术后手术部位感染(surgical site infection,SSI)的疗效及对炎性因子水平的影响.方法:选取2016年8月至2018年7月东营市人民医院收治的拟行手术治疗的腰椎退变性疾病患者596例,根据随机数字表法分为治疗组与对照组,每组298例.对照组患者术前30 min静脉注射头孢辛钠2.0 g,术中每3 h追加1次;治疗组患者在对照组常规抗菌药物预防感染基础上,术中切口关闭前在术野局部应用万古霉素1.0 g预防感染.观察两组患者的感染率和感染特征,比较术前,术后1、3、5、7、14 d及6周的C反应蛋白(CRP)、降钙素原(PCT)及红细胞沉降率(ESR)等指标水平的差异,收集患者并发症发生情况.结果:治疗组患者术后SSI发生率为0.67%(2/298),明显低于对照组的5.03%(15/298),差异有统计学意义(P<0.05);治疗组患者浅切口感染率、深切口感染率明显低于对照组,感染持续时间、手术至感染发作时间明显短于对照组,差异均有统计学意义(P<0.05).术后1、3、5、7及14 d,治疗组患者CRP水平明显低于对照组;术后1、3、5、7、14 d及6周,治疗组患者PCT、ESR水平明显低于对照组,差异均有统计学意义(P<0.001).围术期,治疗组患者无低血压与肾毒性等严重并发症发生,对照组2例患者发生脑脊液漏.结论:局部应用万古霉素能够有效降低腰椎手术患者术后SSI的发生率,降低炎性因子水平,减少术后并发症的发生.
OBJECTIVE:To probe into the efficacy of local application of vancomycin in preventing surgical site infection(SSI)after lumbar spine surgery and its effect on inflammatory factors.METHODS:596 patients with lumbar degenerative disease undergoing surgery in Dongying People’s Hospital from Aug.2016 to Jul.2018 were selected and divided into treatment group and control group via random number table,with 298 cases in each group.The control group was given 2.0 g of cefotaxime sodium for intravenous injection at 30 min before surgery,and another dose was added every 3 hours during the surgery.On the basis of conventional antibiotics therapy in the control group,1.0 g of vancomycin was locally applied to prevent infection before incision closed in the treatment group.The rates and characteristics of infection of two groups were observed,differences in C-reactive protein(CRP),procalcitonin(PCT)and erythrocyte sedimentation rate(ESR)before surgery and 1 day,3 days,5 days,7 days,14 days and 6 weeks after surgery were compared between two groups,incidences of complications were collected.RESULTS:The postoperative SSI rate of treatment group was 0.67%(2/298),which was significantly lower than that of the control group(5.03%,15/298),with statistically significant difference(P<0.05);the infection rates of shallow incision and deep incision of treatment group were significantly lower than those of the control group,the duration of infection and time from surgery to infection of treatment group were significantly shorter than those of the control group,with statistically significant difference(P<0.05).At 1 day,3 days,5 days,7 days and 14 days after surgery,the CRP levels of treatment group were significantly lower than those of the control group;at 1 day,3 days,5 days,7 days,14 days and 6 weeks,the PCT and ESR levels of treatment group were significantly lower than those of the control group,with statistically significant difference(P<0.001).During perioperative period,no severe complications such as hypotension and nephrotoxicity occurred in the treatment group,while cerebrospinal fluid leakage occurred in 2 patients in the control group.CONCLUSIONS:Local application of vancomycin can effectively lower the incidence of postoperative SSI,reduce inflammatory factor level and postoperative complications.
作者
刘广泉
李登军
刘健健
于学忠
李海亮
杜晓波
LIU Guangquan;LI Dengjun;LIU Jianjian;YU Xuezhong;LI Hailiang;DU Xiaobo(Dept.of Spinal Surgery,Dongying People’s Hospital,Shandong Dongying 257091,China;Dept.of Orthopedics,People’s Hospital of Shandong Guangrao County,Shandong Dongying 257300,China)
出处
《中国医院用药评价与分析》
2019年第12期1482-1484,1487,共4页
Evaluation and Analysis of Drug-use in Hospitals of China
基金
山东省医药卫生科技发展计划项目（No.2016HZ038）
关键词
腰椎手术
术后感染
万古霉素
C反应蛋白
降钙素原
Lumbar spine surgery
Postoperative infection
Vancomycin
C-reactive protein
Procalcitonin
