下颈椎损伤前路手术切口感染围术期危险因素分析及其对护理的指导作用  

Analysis of perioperative risk factors for surgical site infection of subaxial cervical spine injury after anterior surgery and the guiding role in nursing care

作　　者：李水霞 杨俊松 赵松川 郝定均 李翠翠 汪静 胡靖 Li Shuixia;Yang Junsong;Zhao Songchuan;Hao Dingjun;Li Cuicui;Wang Jing;Hu Jing(First Department of Surgery and Anesthesiology,Honghui Hospital,Xi'an Jiaotong University Faculty of Medicine,Xi'an 710054,China;Department of Spine Surgery,Honghui Hospital,Xi'an Jiaotong University Faculty of Medicine,Xi'an 710054,China)

机构地区：[1]西安交通大学医学部附属红会医院手术麻醉一科,710054 [2]西安交通大学医学部附属红会医院脊柱外科,710054 [3]西安交通大学医学部附属红会医院护理部,710054

出　　处：《中华创伤杂志》2020年第9期820-826,共7页Chinese Journal of Trauma

基　　金：国家自然科学基金重点项目(81830077)。

摘　　要：目的探讨下颈椎损伤前路手术切口感染(SSI)围术期危险因素,为改进护理措施提供依据。方法采用回顾性病例对照研究分析2014年1月-2018年1月西安交通大学医学部附属红会医院收治的754例下颈椎损伤行颈前路手术患者临床资料,其中男511例,女243例;年龄44~61岁[(50.2±5.1)岁]。骨折节段:C360例,C4159例,C5197例,C6236例,C7102例。按照术后是否发生SSI将患者分为感染组(28例)和无感染组(726例)。统计两组患者的人口学资料、美国脊髓损伤协会(ASIA)分级、合并症、饮食护理、备皮至手术时间、是否术前导尿、是否接台手术、参与手术人数、手术室层流级别、手术室温度、手术室相对湿度、手术时间、是否有上台实习护士及手术方式等信息。通过单因素分析筛选两组间差异有统计学意义的指标,进一步采用多因素Logistic回归分析与SSI发生的危险因素。结果术后SSI发生率为3.71%(28/754)。单因素分析结果显示,两组ASIA分级、糖尿病、饮食护理、备皮至手术时间、术前留置尿管、接台手术、参与手术人数、手术室层流级别及手术时间差异有统计学意义(P<0.01)。多因素Logistic回归分析结果显示,ASIA分级(A级:OR=84.421,B级:OR=27.200,P<0.01)、糖尿病(OR=3.234,P<0.05)、未行饮食护理(OR=2.375,P<0.05)、备皮至手术时间≥6 h(OR=2.542,P<0.05)、术前留置尿管(OR=4.085,P<0.01)、接台手术(OR=2.894,P<0.05)、参与手术人数≥8人(OR=3.137,P<0.01)、万级及以上手术间(OR=5.380,P<0.01)及手术时间≥3 h(OR=2.405,P<0.05)与SSI呈正相关。结论ASIA分级(A级和B级)、糖尿病、未行饮食护理、备皮至手术时间≥6 h、术前留置尿管、接台手术、参与手术人数≥8人、手术室层流级别(万级及以上)及手术时间≥3 h是下颈椎损伤前路手术SSI的危险因素。提示对于下颈椎损伤患者,应重视饮食护理,加强血糖监控,优化手术室管理。Objective To investigate the perioperative risk factors of surgical site infection(SSI)of subaxial cervical spine injury after anterior surgery and provide a basis for the development of nursing measures.Methods A retrospective case-control study was conducted to analyze the clinical data of 754 patients with subaxial cervical spine injury who underwent anterior surgery from January 2014 to January 2018,including 511 males and 243 females,aged 44-61 years[(50.2±5.1)years].The fracture segment was C3 in 60 patients,C4 in 159,C5 in 197,C6 in 236 patients,and C7 in 102.The patients were divided into two groups according to SSI occurrence.There were 28 patients in infected group and 726 patients in non-infected group.Data of the two groups were recorded,such as demographic data,American Spinal Injury Association(ASIA)scale,comorbidity,time interval from skin preparation to operation,preoperative urinary catheterization or not,consecutive operation or not,total number of staff involved in the operation,layer flow level of operating room,operating room temperature,relative humidity,operation duration,intern nurse involved in the operation or not and surgical methods.Univariate analysis was used to screen the indicators with statistically significant differences between the two groups.Multivariate Logistic regression analysis was further used to identify the risk factors of SSI.Results The occurrence rate of SSI was 3.71%(28/754).The univariate analysis showed that there were significant differences between the two groups in ASIA scale,diabetes,dietary nursing,time interval from skin preparation to operation,preoperative urinary catheterization,consecutive operation,total number of staff involved in the operation,layer flow level of operating room and operation duration(P<0.01).The multivariate Logistic regression analysis showed that the ASIA scale(grade A:OR=84.421,grade B:OR=27.200,P<0.01),diabetes(OR=3.234,P<0.05),without diet nursing(OR=2.375,P<0.05),time interval from skin preparation to operation≥6 h(OR=2.542,

关 键 词：颈椎 脊柱骨折 感染 手术室护理 危险因素 

分 类 号：R473.6[医药卫生—护理学]