本文選題：腰椎 + 白蛋白　； 參考：《南昌大學》2017年碩士論文

【摘要】：目的:分析腰椎后路手術(shù)后切口感染發(fā)生情況及其相關(guān)危險因素,為臨床預(yù)防提供參考。方法:回顧性分析2010年1月至2016年8月因腰椎疾病在我院行腰椎后路手術(shù)治療的2715例患者的臨床資料,包括腰椎間盤突出癥1075例(39.59%),腰椎滑脫癥611例(22.50%),腰椎椎管狹窄癥580例(21.36%),腰椎骨折449例(16.54%)。按性別、體重指數(shù)、主要診斷等進行匹配,從同期行腰椎后路手術(shù)患者的數(shù)據(jù)庫中按3:1比例選擇術(shù)后無并發(fā)癥的患者作為對照組進行數(shù)據(jù)分析。記錄并分析患者年齡、合并癥、手術(shù)方式、手術(shù)時間、術(shù)中失血量、術(shù)中輸血情況、手術(shù)節(jié)數(shù)、術(shù)前及術(shù)后血細胞分析、肝腎功能、電解質(zhì)和術(shù)后拔除引流管時間與切口感染的關(guān)系。采用SPSS19.0統(tǒng)計軟件對計量資料采用t檢驗分析;對計數(shù)資料采用X2檢驗或Fisher確切概率檢驗進行比較。對每個單因素分析得出有統(tǒng)計學意義的變量再用多因素分析,將以P0.05為差異具有統(tǒng)計學意義。結(jié)果:總共64例(2.36%)患者術(shù)后發(fā)生切口感染,其中男性46例,女性18例,年齡27-77歲,手術(shù)年齡58.30±10.44歲。原始疾病為椎間盤突出癥18例,腰椎滑脫11例,腰椎椎管狹窄21例,腰椎骨折14例。單因素分析顯示:術(shù)前合并糖尿病;術(shù)前紅細胞、血紅蛋白、總蛋白、白蛋白、血清鈣;手術(shù)方式、手術(shù)時間、麻醉時間、手術(shù)節(jié)數(shù)、術(shù)中出血量、麻醉等級;術(shù)后紅細胞、血紅蛋白、白蛋白、球蛋白、血小板、血清鈣和拔管時間與對照組相比差異具有統(tǒng)計學意義(P0.05)。進一步二分類Logistic回歸分析顯示:術(shù)前合并糖尿病(OR=2.488,P=0.020)、術(shù)前白蛋白下降(OR=0.863,P=0.017)、術(shù)前血清鈣下降(OR=0.018,P=0.007)、手術(shù)節(jié)數(shù)(OR=2.329,P=0.000)、術(shù)后血紅蛋白降低(OR=0.950,P=0.008)、術(shù)后白蛋白降低(OR=0.897,P=0.035)、術(shù)后球蛋白升高(OR=1.082,P=0.008)和拔出引流管時間延長(OR=1.493,P=0.016)是腰椎術(shù)后切口感染的獨立危險因素。結(jié)論:糖尿病、術(shù)前白蛋白下降、術(shù)前血清鈣下降、手術(shù)節(jié)數(shù)、術(shù)后血紅蛋白降低、術(shù)后白蛋白降低、術(shù)后球蛋白升高和拔出引流管時間延長是腰椎后路術(shù)后切口感染的重要危險因素。圍手術(shù)期應(yīng)注意處理術(shù)前合并癥,監(jiān)測血紅蛋白、白蛋白、球蛋白和電解質(zhì)的變化,有助于預(yù)防腰椎術(shù)后切口感染的發(fā)生。
[Abstract]:Objective: to analyze the incidence and risk factors of incision infection after lumbar posterior approach surgery, and to provide reference for clinical prevention. Methods: the clinical data of 2715 patients with lumbar spine disease treated by posterior lumbar surgery from January 2010 to August 2016 were retrospectively analyzed. There were 1075 cases of lumbar disc herniation, 611 cases of lumbar spondylolisthesis, 580 cases of lumbar spinal stenosis, and 449 cases of lumbar fracture. According to gender, body mass index (BMI) and main diagnosis, the data were analyzed from the database of patients undergoing lumbar posterior approach operation in the same period. The patients without complications were selected as the control group according to the 3:1 ratio. To record and analyze the patients' age, complications, operative methods, operative time, intraoperative blood loss, blood transfusion during operation, number of operative segments, blood cell analysis before and after operation, liver and kidney function. The relationship between electrolyte and the time of pulling out drainage tube after operation and wound infection. The SPSS19.0 statistical software was used to analyze the measurement data by t-test, and the count data was compared by using X2 test or Fisher exact probability test. For each single factor analysis, the variables with statistical significance were analyzed with multivariate analysis, and the difference was statistically significant with P0.05. Results: a total of 64 patients (male 46, female 18, age 27-77, operative age 58.30 鹵10.44) developed incision infection after operation. The primary diseases included intervertebral disc herniation (18 cases), lumbar spondylolisthesis (11 cases), lumbar spinal stenosis (21 cases) and lumbar fracture (14 cases). Univariate analysis showed that: preoperative diabetes mellitus; preoperative erythrocyte, hemoglobin, total protein, albumin, serum calcium; operation mode, operation time, anesthetic time, number of operative segments, intraoperative bleeding, anesthetic grade; postoperative red blood cell, Hemoglobin, albumin, globulin, platelet, serum calcium and extubation time were significantly different from the control group (P 0.05). Further two classification Logistic regression analysis showed: preoperative diabetes complicated with OR 2.488 P0.020, preoperative albumin decreased OR0.863P0. 017, preoperative serum calcium decreased OR0. 018 P0. 007, operation section decreased OR0.950 P0. 008, postoperative albumin decreased OR0. 897 P0. 035, globulin increased OR1. 082 P0. 008). Prolongation of drainage tube time was an independent risk factor for incision infection after lumbar vertebra operation. Conclusion: in diabetes mellitus, the preoperative albumin, the preoperative serum calcium, the number of operative segments, the postoperative hemoglobin and the postoperative albumin were decreased. Elevated globulin and prolonged drainage time are important risk factors for postoperative incision infection. Perioperative management should be paid attention to preoperative complications, monitoring the changes of hemoglobin, albumin, globulin and electrolyte, which is helpful to prevent postoperative incision infection.
【學位授予單位】：南昌大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R687.3

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