脊柱手术后切口深部感染的早期判断

Early diagnosis of deep infection after spine surgeries

中文关键词:  脊柱手术  手术切口深部感染  感染相关指标

英文关键词:Spine surgery  Surgical site infection  Infection-related indicator

中文摘要:

  【摘要】 目的：观察脊柱术后早期各项感染相关指标的变化情况，为尽早判断切口深部感染的存在提供更为可靠的依据。方法：2001年1月~2012年12月在复旦大学附属华山医院脊柱外科中心行脊柱手术的患者中，术后发生切口深部感染24例（感染组），男20例，女4例；年龄55.0±15.0岁（14~75岁）；急性感染14例（术后3个月内发生），迟发性感染10例（术后3个月后发生）。以同时间段行脊柱手术、术后未出现感染的51例患者（男29例，女22例；年龄19~81岁）作为对照组。回顾性分析两组患者术后第3天及术后第5/6天外周血中白细胞总数、中性粒细胞总数、红细胞沉降率（ESR）及C-反应蛋白（CRP）等参数，同时回顾相应时间点患者体温与局部伤口情况。以白细胞总数、中性粒细胞总数、CRP、ESR及体温等参数超过对照组患者相应时间点该参数值的均数+2倍标准差（x+2s）作为上述参数异常的标准；局部伤口以出现红肿热痛、伴或不伴渗出作为异常的标准。结果：与对照组比较，切口深部感染组患者术后3d的CRP显著性升高（P=0.005）；术后5/6d，CRP（P=0.000）、中性粒细胞总数（P=0.020）及体温（P=0.001）均显著性增高。在术后3d或5/6d时，24例患者中共有8例（33.3%）体温增高；2例（8.3%）白细胞总数升高，11例（45.8%）中性粒细胞总数升高；18例（75%）ESR升高，21例（87.5%）CRP升高；3例（12.5%）在术后短期内（<1周）出现手术伤口部位红肿热痛，伴或不伴渗出。CRP及ESR等参数对于切口深部感染诊断的敏感性明显高于体温、伤口局部体征及白细胞总数与中性粒细胞总数等感染相关指标（P<0.05）。迟发性切口深部感染患者外周血各项炎症指标与急性切口深部感染患者比较无统计学差异（P>0.05）。结论：术后早期定时检测周围血中CRP和ESR有利于早期判断切口深部感染，CRP升高可在早期有效判断切口深部感染。

英文摘要:

  【Abstract】 Objectives: To investigate the early changes of various infection-related indicators after spine surgeries, and to provide more reliable evidence for the early diagnosis of deep infection. Methods: 24 patients(20 males and 4 females, with age ranging from 14 to 75 years old) diagnosed as deep surgical site infection in Spine Surgery Center of Huashan Hospital, Fudan University between January 2001 and December 2012 were reviewed retrospectively. Meanwhile, 51 patients undergoing spine surgeries in the same period without postoperative surgical site infection were enrolled in control group(29 males and 22 females, with age ranging from 19 to 81 years old). The leukocyte counts, neutrophil counts, erythrocyte sedimentation rate(ESR) and C-reactive protein(CRP) in the peripheral blood, as well as body temperature and local wound conditions of all patients were recorded on the 3rd and 5/6th day postoperatively. The leukocyte counts, neutrophil counts, ESR, CRP and body temperature were considered abnormal when they exceeded x+2s than those of the control group. Local wound conditions were considered abnormal when presented with redness, swelling, heat and pain with or without exudation. Results: Compared with the control group, patients with deep surgical site infection showed higher CRP value(P=0.005) on 3 days postoperatively, and higher CRP value(P=0.000), neutrophil counts(P=0.020) and body temperature(P=0.001) on 5/6 days postoperatively. In 24 patients with postoperative deep surgical site infection, 8 patients(33.3%) showed abnormal fervescence. 2 patients(8.3%) showed abnormal increase of leukocyte counts. 11 patients(45.8%) showed abnormal increase of neutrophil counts. 18 patients(75%) showed significantly higher ESR than the control group, while 21 patients(87.5%) showed significantly higher CRP value. Only 3 patients(12.5%) presented with redness, swelling, heat and pain with or without exudation in 1 week postoperatively. Therefore, the sensitivity of CRP and ESR in diagnosing deep surgical site infection was significantly higher than that of other indicators, such as body temperature, local wound conditions, leukocyte counts and neutrophil counts(P<0.05). Although there was no abnormal fever or local wound problem, no significant difference of various infection indicators in the peripheral blood was noted between the patients with acute or delayed deep infection(P>0.05). Conclusions: Early routine quantitative evaluation of the abnormal changes of various infection indicators in the peripheral blood, especially CRP value is an effective way to diagnose deep surgical site infection, particularly in the patients with delayed deep surgical site infection and without obvious fever and/or local wound infection presentation.