腰椎融合手术中不同的冲洗措施对患者围手术期的影响  

Effects of different irrigation measures on perioperative patients with lumbar spinal fusion

作　　者：陈栋[1] 蒋欣[1] CHEN Dong JIANG Xin.(Department of Spinal Surgery, China-Japan Friendship Hospital,Beijing,100029 China)

机构地区：[1]中日友好医院脊柱外科,北京100029

出　　处：《颈腰痛杂志》2017年第4期295-298,共4页The Journal of Cervicodynia and Lumbodynia

摘　　要：目的探讨不同的术中冲洗措施对腰椎融合手术患者围手术期的影响。方法于2014-05-2015-05,共纳入我科收治的单节段腰椎融合内固定手术患者151例,随机分为3组,术中分别采用3种不同的冲洗措施:A组51例仅于缝合切口前,采用终末期生理盐水冲洗,冲洗液用量为2000 m L左右;B组52例则在A组基础上,于术中行持续生理盐水冲洗(液体温度为15℃);C组48例的冲洗方式与B组一致,但持续冲洗时采用抗生素生理盐水溶液(含有800mg/L的庆大霉素+1000 mg/L的头孢唑林)。结果对比术中出血量、术后24 h引流量、VAS评分和术后住院时间,B、C组均显著低于A组(P<0.05),WBC的升高程度明显低于A组(P<0.05);B、C组之间无显著性差异(P>0.05)。A组发生切口感染4例(7.8%),B组发生1例(1.9%),C组无细菌感染,3组之间无显著性差异(P>0.05)。结论在腰椎融合手术中采用持续冲洗有利于降低术中出血量,减轻术后切口疼痛,对预防切口感染也有一定的价值;但持续抗生素溶液冲洗的意义并不大,仅应用生理盐水即可。Objective To investigate the effects of different irrigation methods on the perioperative period of patients undergoing lumbar fusion surgery. Methods From May 2014 to May 2015, 151 cases with single segment lumbar fusion and internal fixation were randomly divided into 3 groups. Patients were treated with 3 different irrigation measures： 51 patients of A group received end- stage physiological saline, flushing fluid volume was about 2000 mL; 52 cases of B group received intraoperative continuous physiological saline （liquid temperature of 15~C） based on A group; 48 cases of group C received flushing means consistent with the B group, but continued flushing with antibiotic saline solution （containing 800 mg/L of gentamicin＋1000 mg/L cefazolin）. Results The amount of intraoperative bleeding, postoperative 24 h drainage, VAS score and postoperative hospitalization time of group B and group C were significantly lower than those of A group（P〈0.05）. The increased level of WBC of group B and group C was significantly lower than that of A group （P〈0.05）. There were no significant differences between group B and group C （P〉O.05）. In group A, there were 4 cases of incision infection （7.8%）, 1 case in group B （1.9%）, no bacterial infection in group C, there was no significant difference among the three groups （P〉0.05）. Conclusion The lumbar fusion surgery using continuous irrigation can reduce the amount of bleeding, reduce postoperative pain, also has a certain value for the prevention of incision infection; but continuous antibiotic solution rinse has no clinical significance, saline can be used only.

关 键 词：腰椎融合手术 冲洗切口 围手术期 

分 类 号：R687.3[医药卫生—骨科学]