临床诊断与病原确诊脊柱术后感染的临床特征对比  

Clinical comparison of clinically-suspected and etiologically-confirmed surgical site infections after spine surgery

作　　者：刘少强[1,2] 齐强[1] 陈仲强[1] 刘宁[1] 郭昭庆[1] 孙垂国[1] 李危石[1] 曾岩[1] 刘忠军[1] 

机构地区：[1]北京大学第三医院骨科,北京100191 [2]厦门大学附属福州第二医院脊柱外科,福州350007

出　　处：《中国矫形外科杂志》2016年第11期1006-1009,共4页Orthopedic Journal of China

基　　金：北京市科学技术委员会首都临床特色应用研究专项基金(编号:Z141107002514025);首都卫生发展科研专项基金(编号:2014-3-4096)

摘　　要：[目的]比较临床诊断与病原确诊脊柱术后感染的临床特征,为脊柱术后手术部位感染的临床诊治提供帮助。[方法]回顾性分析2004年7月-2012年12月北京大学第三医院28 778例脊柱手术后发生感染的108例患者的病历资料,分为病原确诊组（67例）和临床诊断组（41例）,从一般资料、临床表现、实验室检查等方面对两组资料进行综合分析。[结果]108例患者中男56例,女52例,平均年龄49.7岁,感染率为0.38%。常见的临床表现为切口渗液（69.4%）、体温升高（62.0%）、白细胞升高（49.1%）、中性粒细胞百分数升高（44.4%）、切口红肿（37.0%）和切口疼痛（30.6%）。临床诊断组的体温[（37.45±1.06）℃vs（38.00±1.10）℃,P=0.012]、白细胞[（9.33±3.37）×10-9/L vs（11.38±5.44）×10-9/L,P=0.032]和中性粒细胞百分数[（70.91±10.42）%vs（78.63±13.25）%,P=0.002]均低于病原确诊组。[结论]脊柱术后手术部位感染最主要的临床特征为切口渗液和体温升高。缺乏病原学证据的脊柱术后手术部位感染病例,其感染指标变化程度小于病原确诊病例。[Objective] To compare the clinical characteristics of clinically- suspected and etiologically- confirmed surgical site infection（ SSI） after spine surgery,so as to provide advice for clinical diagnosis and treatment of SSI. [Methods] A total number of 108 patients with surgical site infection after spine surgery,who were admitted into Peking University Third Hospital from July 2004 to December 2012,were divided into 2 groups： etiologically- confirmed group（ n = 67 cases） and clinically- suspected group（ n = 41 cases）. The patients included 56 males and 52 females,with a mean age of 49. 7 years. We retrospectively analyzed the clinical data,including general information,risk factors,clinical symptoms and laboratory tests. [Results] The infection rate was 0. 38%. Common clinical characteristics included incisional drainage（ 69. 4%）, fever（ 62. 0%）,elevated white blood cell（ 49. 1%）,elevated percentage of neutrophils（ 44. 4%）,incisional swelling（ 37. 0%）and incisional pain（ 30. 6%）. Compared with the results from etiologically- confirmed group,temperature,white blood cell and percentage of neutrophils were found to be lower in clinical- suspected group, with statistically significant difference（ 37. 45 ± 1. 06℃ vs 38. 00 ± 1. 10℃,P = 0. 012; 9. 33 ± 3. 37 × 10-9/ L vs 11. 38 ± 5. 44 × 10-9/ L,P = 0. 032; 70. 91 ±10. 42% vs 78. 63 ± 13. 25%,P = 0. 002）. [Conclusion] The most common clinical characteristics of SSI after spine surgery are incisional drainage and fever. The scale variation degree of infectious indicators of clinical- suspected infection is lower than that of etiologically- confirmed infection.

关 键 词：脊柱手术 手术部位感染 临床特征 回顾性研究 

分 类 号：R687.3[医药卫生—骨科学]