局部应用万古霉素预防脊柱手术部位感染的Meta分析

Local application of vancomycin powder to prevent spinal surgical site infections: a meta-analysis

中文关键词:  脊柱手术  手术部位感染  局部应用  万古霉素粉末  Meta分析

英文关键词:Spine surgery  Surgical site infections  Local application  Vancomycin powder  Meta-analysis

中文摘要:

  【摘要】 目的：系统评价术中局部应用万古霉素粉末（vancomycin powder，VP）预防脊柱术后手术部位感染（sur?鄄gical site infections，SSIs）的疗效。方法：计算机检索Medline数据库（Pubmed）、Embase数据库、中国生物医学文献数据库（CBM）以及中国期刊全文数据库（CNKI）中2015年4月1日以前的文献，搜集关于脊柱手术中切口内局部应用VP的对照研究。两名研究人员独立按纳入和排除标准筛选文献，评价文献质量以及提取数据，采用Revman 5.3软件进行数据分析。结果：最终纳入11篇文献，包括10项回顾性队列研究和1项随机对照试验，共5155例患者。根据纳入文献提供的信息进行3项亚组分析，分别比较局部应用VP对脊柱常规手术和矫形手术术后感染率的影响，对脊柱内固定手术和非固定手术术后感染率的影响，以及对脊柱手术后浅表和深部切口感染率的影响，发现局部应用VP能显著降低脊柱常规手术后感染风险（OR=0.27，95% CI 0.12~0.57，P=0.0007）和脊柱内固定术后感染风险（OR=0.33，95% CI 0.17~0.66，P=0.001），并能有效预防术后深部切口感染（OR=0.33，95% CI 0.14~0.77，P=0.01），但对于脊柱矫形手术、非内固定手术的术后感染以及浅表切口感染的预防效果则不明确（P>0.05）。结论：术中局部应用VP能够降低脊柱常规手术和脊柱内固定手术的术后感染风险，并能有效预防术后深部切口感染。

英文摘要:

  【Abstract】 Objectives: To estimate the effectiveness of local application of vancomycin powder(VP) to prevent surgical site infections(SSIs) after spine surgery. Methods: A computer-based online search of Medline(Pubmed), Embase, CBM and CNKI for articles published before April 1st, 2015 was performed to collect comparative studies of intrawound vancomycin in spine surgery. Two reviewers independently screened eligible articles based on inclusion and exclusion criteria, assessed study quality and extracted data. Revman 5.3 software was used for data analysis. Results: 11 articles which encompassed 5,155 surgical patients were finally identified for meta-analysis, including 10 respective cohort studies and 1 randomised controlled trial. According to the information given by the literature identified, three subgroup analysis was conducted that respectively compared the effects of topical application of VP on SSIs rates of spinal routine operation, corrective operation, instrumented and noninstrumented operation, and rates of superficial and deep SSIs. The results suggested that local application of VP could significantly reduce the risk of SSIs after spinal routine operation(OR=0.27, 95% CI 0.12-0.57, P=0.0007) and instrumented operation(OR=0.33, 95% CI 0.17-0.66, P=0.001), and could effectively prevent deep SSIs(OR=0.33, 95% CI 0.14-0.77, P=0.01), while the influence on superficial SSIs and infections after corrective operation and noninstrumented operation were still unclear(P>0.05). Conclusions: The local application of VP appears to protect against deep SSIs and infections after spinal routine operation and instrumented operation.