脊柱手术患者手术部位感染目标性监测  

Targeted monitoring of surgical site infections in patients undergoing spinal surgery

作　　者：杨俊林 查筑红 杨昆 罗光英 王敏 程永素 黄冰 YANG Junlin;ZHA Zhuhong;YANG Kun;LUO Guangying;Wang Min;CHENG Yongsu;HUANG Bing(Department of Nosocomial Infection Prevention and Control,The Affiliated Hospital of Guizhou Medical University,Guiyang,Guizhou 550004,China;Department of General Ward,The Guizhou Provincial People's Hospital,Guiyang,Guizhou 550002,China)

机构地区：[1]贵州医科大学附属医院医院感染管理科,贵阳550004 [2]贵州省人民医院综合病房,贵阳550002

出　　处：《重庆医学》2019年第A01期62-65,共4页Chongqing medicine

基　　金：中国老年医学会感染防控研究基金资助项目(GRYJ-KLB2018028)。

摘　　要：目的了解某三级甲等教学医院骨科Ⅰ类切口脊柱手术患者手术部位感染(SSI)情况及围手术期抗菌药物的使用,为预防SSI及合理使用抗菌药物提供科学依据。方法采用前瞻性调查方法,对2018年1月1日至9月30日贵州医科大学附属医院医院骨科进行的所有Ⅰ类清洁切口脊柱手术进行了目标监测,对无植入物手术患者监测至术后30d,有植入物患者监测至术后90d,观察SSI率及围手术期抗菌药物使用率。结果共监测骨科Ⅰ类清洁切口脊柱手术345例,SSI6例次,感染率为1.74%;B医生调整感染率最高;年龄大于或等于60岁、糖尿病和(或)高血压与SSI发生有关;围手术期抗菌药物预防使用率达97.10%;手术时间大于3h者216例,未追加使用抗菌药物31例;术后使用抗菌药物317例,术后持续时间大于48h者占86.75%,第1、2代头孢菌素使用率为85.80%。结论骨科Ⅰ类切口脊柱手术SSI还有下降空间;围手术期抗菌药物使用不规范,应将抗菌药物使用率和使用强度控制在合理范围内,有效控制细菌耐药。Objective To investigate the surgical site infection(SSI) and the use of antibiotics in perioperative period in patients undergoing spinal surgery of type Ⅰ incision surgery in a tertiary teaching hospital,so as to provide scientific basis for the prevention of SSI and the rational use of antibiotics. Methods Prospectively targeted monitoring survey was used to investigate all patients undergoing spinal surgery of type Ⅰ incision,who were admitted to the orthopaedic department of The Affiliated Hospital of Guizhou Medical University from January 1,2018 to September 30,2018 to analyse the incidence of SSI and the perioperative use of antimicrobial agents. Patients without implants were monitored to 30 d postoperatively,and patients with implants were monitored to 90 d postoperatively. Results Among the 345 patients undergoing spinal surgery of type Ⅰ incision surgery investigated,6 cases surgical site infections were found with an infection the rate was 1.74%;the adjust infection rates of doctor B was high among the surgeons;age over 60,diabetes mellitus and/or hypertension are associated with SSI;the use rate of antimicrobial agents during the peroperative period was 97.10%;Among 216 cases with operation time >3 hours,31 cases did not use additional antibiotics;317 cases were treated with antibiotics after operation,the proportion of the patients with the duration longer than 48 hours was 86.75%,and the proportion of the first and second generation cephalosporins was 85.80%. Conclusion SSI of spinal surgery of type Ⅰ incision in the orthopaedic department still has declined space;the use of antibiotics in perioperative period is not standardized,so the use rate and intensity of antibiotics should be controlled within a reasonable range to effectively control bacterial resistance.

关 键 词：Ⅰ类切口手术 脊柱手术 目标性监测 手术部位感染 抗菌药物 

分 类 号：R619.3[医药卫生—外科学]