稀碘伏溶液浸泡术野对降低术后脊柱手术切口感染风险的效果

Evaluation of dilute betadine immersion in reducing postoperative surgical site infection after spine surgery

中文关键词:  脊柱手术  切口感染  碘伏

英文关键词:Spine surgery  Surgery site infection  Betadine

中文摘要:

  【摘要】 目的：评价在脊柱手术关闭切口前使用稀碘伏溶液浸泡术野对降低术后切口感染的效果。方法：搜集从2010年1月～2014年12月由我院骨科同一术者实施手术的患者资料，排除其中椎体成形手术、原发感染手术、Halo头环固定术、椎间孔镜手术及内固定取出手术。共计纳入706例满足条件的脊柱手术患者作为观察对象。对照组为2010年1月～2012年12月进行的311例脊柱手术患者，在关闭切口前使用1000～1500ml生理盐水冲洗术野。观察组为2013年1月～2014年12月进行的395例脊柱手术患者，在关闭切口前使用1%的稀碘伏溶液浸泡术野2min后用生理盐水冲洗一遍。观察术后两组患者切口感染发生情况，并对两组变量和感染率进行统计学分析。结果：观察组和对照组患者在年龄、性别、BMI指数、贫血人数、低蛋白血症人数、糖尿病人数、手术入路、节段涉及、术中失血量、术中输血量等指标上没有统计学差异（P<0.05）。对照组311例患者中9例（2.9%）发生了术后切口感染，2例（0.6%）为表浅切口感染，7例（2.3%）为深部切口感染；观察组395例患者中仅1例（0.2%）发生切口感染，为浅表切口感染。两组患者在总切口感染率（P=0.009）和深部切口感染率（P=0.009）上有统计学差异。单因素分析结果显示是否使用稀碘伏溶液浸泡是影响术后感染的重要因素。结论：在脊柱手术关闭切口前使用稀碘伏溶液浸泡术野是一种有效、简单、廉价、值得推荐的能降低术后切口感染风险的方法。但其更确切的效果以及最佳的标准化操作方法有待更大规模、证据等级更高的研究予以揭示。

英文摘要:

  【Abstract】 Objectives: To evaluate the role of intra-operative 1% dilute betadine solution immersion in prevention of surgical site infection(SSI) of spinal surgery. Methods: The study included 706 adult patients from January 2010 to December 2014 who underwent spine surgery by the same surgeon. The surgery such as vertebroplasty, debridement, Halo-Vest placement, percutaneous endoscopic spinal surgery, instrumentation removal were excluded. 1000-1500ml normal saline irrigation was used before wound closure in 319 patients from January 2010 to December 2012 as group 1. A two-minute 1% betadine solution immersion and a normal saline irrigation were used for the 387 patients from January 2013 to December 2014 as group 2. Results: 9 SSI occured in group 1(2.8%) including 2 superficial infections(0.6%) and 7 deep infections(2.3%). Only 1 superficial infection(0.2%) occured in group 2. The differences of total infection rate(P=0.009) and deep infection rate(P=0.009) between the two groups were statistically significant. Most variables between the two groups were comparable. Conclusions: Dilute betadine irrigation is an effective, simple and cheap way to reduce surgical site infection rate after spinal surgery. A higher-level and larger-scale study to explore the accurate efficacy and an optimal operation standard is still needed.