| 冯利君,张允帅,王宸,等.脊柱侧凸融合术手术部位感染的危险因素及血清 PCT、CRP检测的预测价值[J].安徽医药,2021,25(7):1419-1423. |
| 脊柱侧凸融合术手术部位感染的危险因素及血清 PCT、CRP检测的预测价值 |
| Risk factors of surgical site infection after scoliosis fusion and clinical predictive value of se? rum PCT and CRP |
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| DOI：10.3969/j.issn.1009-6469.2021.07.036 |
| 中文关键词: 外科伤口感染 脊柱侧凸 脊柱融合术 降钙素原 C反应蛋白质 危险因素 预测价值 |
| 英文关键词: Surgicalwoundinfection Scoliosis Spinalfusion Procalcitonin C-reactiveprotein Riskfactors Predictivevalue |
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| 中文摘要: |
| 目的探讨脊柱侧凸后路矫形融合术后手术部位感染发生的危险因素及不同时间点血清降钙素原(PCT)和 C-反应蛋白(CRP)检测的临床预测价值，为术后手术部位感染的预防提供参考。方法收集开封市中心医院 2013年 1月至 2019年 12月因脊柱侧凸行后路矫形融合术治疗的 395例病人的临床资料，包括病人的性别、年龄、术前诊断、手术节段、术中出血量及手术方式、术后引流、有无发生术后手术部位感染，术前、术后 1d、术后 3d、术后 7d血清 PCT、CRP水平等，采用二元 logistic回归对手术部位感染的危险因素进行分析，并通过绘制 ROC曲线分析不同时间点血清 PCT和 CRP对术后手术部位感染的临床预测价值。结果 22例病人发生术后手术部位感染，感染率为 5.57%(22/395)其中 15例为浅表感染， 7例为深部感染，感染率分别为 3.80%(15/ 395)、 1.77%(7/395)。感染病人术后 3d、7d血清 PCT及 CRP水，平［3d:(1.81±0.73)ng/mL及( 110.00±23.71)mg/L；7d:(2.24±0.69)ng/mL及(130.48±36.14)mg/L］明显高于未感染病人［3d:(1.17±0.40)ng/mL及(76.48±23.76)mg/L；7d:(1.05±0.52)ng/mL及(70.66±26.40)mg/L］，差异均有统计学意义(P<0.05)。多因素 logistic回归分析显示，年龄 ≥60岁、肥胖、营养不良、糖尿病、手术时间 ≥2 h、术中出血量 ≥300 mL、融合节段数 ≥3节、引流管数目 ≥3个、术后 3d及 7d血清 PCT及 CRP水平是引起脊柱侧凸病人术后手术部位感染的独立危险因素( P<0.05)。术后 7d血清 PCT、CRP预测感染的 AUC值( 0.912、0.905)明显高于术后 3d血清 PCT、CRP(0.758、0.844)，术后 7d血清 PCT预测感染的特异度(0.834)明显高于术后 3d血清 CRP(0.718)，差异有统计学意义(P<0.05)。结论引起脊柱侧凸后路矫形融合术后手术部位感染发生的危险因素较多，应针对相关因素进行干预，以降低术后手术部位感染的发生。术后 3d、7d监测血清 PCT、CRP水平，有助于对手术部位感染的预测及早期干预。 |
| 英文摘要: |
| Objective To investigate the risk factors of operative site infection after posterior orthopedic fusion of scoliosis and theclinical predictive value of serum procalcitonin (PCT) and C-reactive protein (CRP) at different time points, and to provide reference for the prevention of postoperative site infection.Methods The clinical data of 395 patients undergoing posterior orthopedic fusion of scoliosis in Kaifeng Central Hospital from January 2013 to December 2019 was collected, and the clinical data included patients' gender,age, preoperative diagnosis, surgical segment, intraoperative blood loss and operation mode, postoperative drainage, whether postoperative operative site infection occurred, serum PCT and CRP levels before, one day after, three days after and seven days after surgery.The risk factors of surgical site infection were analyzed by Binary Logistic regression, and ROC curve was drawn to analyze the clinicalpredictive value of serum PCT and CRP at different time points for surgical site infection.Results Twenty-two patients developed surgical site infection, the infection rate was 5.57% (22/395), 15 cases were superficial infection and 7 cases were deep infection, the infection rates were 3.80% (15/395) and 1.77% (7/395), respectively. The levels of serum PCT and CRP in infected patients at 3 and 7 daysafter operation [3 d: (1.81±0.73) ng/mL and (110.00±23.71) mg/L; 7 d: (2.24±0.69) ng/mL and (130.48±36.14) mg/L] were significantlyhigher than those of uninfected patients [3 d: (1.17±0.40) ng/mL and (76.48±23.76) mg/L; 7 d: (1.05±0.52) ng/mL and (70.66±26.40)mg/L], the differences had statistical significance (P<0.05). Multivariate Logistic regression analysis showed that age ≥60 years, obesity, malnutrition, diabetes, operative time ≥2h, intraoperative blood loss ≥300ml, number of fusion segments ≥3, number of drainagetubes ≥3, and serum PCT and CRP levels 3 days and 7 days after surgery were independent risk factors for postoperative site infection in patients with scoliosis (P<0.05). The AUC of predicted values in serum PCT and CRP in 7 days after the operation (0.912, 0.905) weresignificantly higher than predicted values in serum PCT and CRP at 3 days after the operation (0.758, 0.844). The specificity of serum PCTin predicting infection in 7 days after surgery (0.834) was significantly higher than that of serum CRP in 3 days after surgery (0.718), andthe difference had statistical significance (P<0.05).Conclusion There are many risk factors for surgical site infection after posterior orthopaedic fusion in scoliosis, the relevant factors of surgical site infection shall be intervened, in order to reduce the incidence. MonitoringtheserumPCTand CRPlevelsat 3and 7daysaftersurgeryishelpfulfortheprediction andearlyinterventionofthe surgicalsiteinfection. |
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