脊柱外科手术后切口感染风险预测评估体系的构建  

Construction of a risk prediction and evaluation system for postoperative incisional infection after spinal surgery

作　　者：钟可琪 冯岚[1] 马玥[2] 高钰琳[2] 张雪梅[1] 吴晓亮[1] 王寻壹 易小欢 郑玉荣[1] Zhong Keqi;Feng Lan;Ma Yue;Gao Yulin;Zhang Xuemei;Wu Xiaoliang;Wang Xunyi;Yi Xiaohuan;Zheng Yurong(Division of Spine Surgery,Department of Orthopaedics,Nanfang Hospital,Guangzhou 510515,China;Nursing College,Southern Medical University,Guangzhou 510515,China)

机构地区：[1]南方医科大学南方医院骨科-脊柱外科,广州510515 [2]南方医科大学护理学院,广州510515

出　　处：《中华创伤骨科杂志》2022年第2期161-167,共7页Chinese Journal of Orthopaedic Trauma

基　　金：南方医科大学科研启动计划项目(G618329146);南方医科大学护理研究专项(Y2017011)。

摘　　要：目的构建脊柱外科手术后切口感染风险预测评估体系。方法以失效模式与效应分析(FMEA)为基础,通过文献检索整理出脊柱手术后切口感染的危险因素和评估项目,采用德尔菲专家咨询法进行专家咨询。根据项目的重要性,结合专家意见进行筛选,建立三级评估指标并进行赋分,最终制定术后切口感染风险评估体系。结果经2轮专家咨询问卷,有效回复率为100%。专家咨询权威程度为0.85,可靠性高;专家咨询的肯德尔协调系数为0.525~0.686,协调程度良好(P<0.05)。三级评估指标包括3个一级指标,18个二级指标,54个三级指标。选择的重要风险条目包括术前评估条目6项,术后评估条目18项,经过统计分析,得出6个术前预测指标和12个术后预测指标,按照半定量的方法得出高、中、低风险的风险优先系数范围值。结论本研究依据专家咨询和FMEA的方法,建立了一套脊柱外科手术后切口感染风险因素和评估预测工具。Objective To construct a risk prediction and assessment system for incisional infection after spinal surgery.Methods Based on the failure mode and effect analysis(FMEA),risk factors and assessment indicators of postoperative incisional infection in spinal surgery were sorted out through literature search followed by expert consultation using the Delphi expert consultation method.After three-level assessment indicators were selected according to their importance and expert opinions and assigned by different scores,a risk prediction and evaluation system was constructed for postoperative incisional infection after spinal surgery.Results The 2 rounds of expert consultation questionnaire resulted in an effective response rate of 100%.The degree of expert consultation authority was 0.85,showing high reliability;the Kendall coordination coefficients of expert consultation ranged from 0.525 to 0.686,showing good coordination(P<0.05).The three-level assessment indicators consisted of 3 primary,18 secondary and 54 tertiary ones.After statistical analyses of the important risk indicators selected which consisted of 6 preoperative evaluation ones and 18 postoperative evaluation ones,6 preoperative and 12 postoperative predictive indicators were obtained.The values of risk priority number(RPN)were calculated for high,medium and low risks for postoperative incisional infection using a semi-quantitative method.Conclusion A self-designed system has been constructed for risk prediction and assessment of incisional infection after spinal surgery based on expert consultation and FMEA method.

关 键 词：脊柱疾病 外科伤口感染 预测 失效模式与效应分析 德尔菲专家咨询法 

分 类 号：R687.3[医药卫生—骨科学]