成 鹏,周海宇,尹晓莉,张海鸿,宋鹏杰,张成俊,汪玉良,夏亚一.中国人群脊柱术后手术部位感染相关危险因素的Meta分析[J].中国脊柱脊髓杂志,2017,(8):704-713. |
中国人群脊柱术后手术部位感染相关危险因素的Meta分析 |
中文关键词: 手术部位感染 脊柱手术 危险因素 Meta分析 |
中文摘要: |
【摘要】 目的:系统评价中国人群脊柱术后手术部位感染(surgical site infection,SSI)的危险因素,为临床制定脊柱术后SSI的预防控制措施提供参考依据。方法:计算机检索PubMed(1966年1月~2017年5月)、EMBASE(1974年1月~2017年5月)、Cochrane Library(2017年5期)、CNKI(1994年1月~2017年5月)、CBM(1979年1月~2017年5月)、维普(1989年1月~2017年5月)和万方数据库(1982年1月~2017年5月),纳入关于中国人群脊柱术后SSI发生危险因素的病例-对照研究,检索时限均从建库至2017年5月。两名作者分别进行文献检索、资料提取(包括研究地点、研究时间、样本量、年龄、诊断、手术方式以及暴露因素)以及运用Newcastle-Ottawa Scale(NOS)质量评价量表进行质量评价。采用RevMan 5.3软件进行统计学分析。结果:共纳入29篇文献,包括18486例患者,其中感染组932例,对照组17554例。根据NOS文献质量评价标准进行质量评价,A级文献19篇,B级文献10篇。Meta分析结果显示,与中国人群脊柱术后SSI发生相关的危险因素有:性别(男性)[OR=1.33,95%CI(1.08,1.64),P<0.05]、年龄(>60岁)[OR=1.44,95%CI(1.01,2.04),P<0.05]、肥胖[OR=2.64,95%CI(1.35,5.15),P<0.05]、糖尿病[OR=3.86,95%CI(2.68,5.55),P<0.05]、感染史[OR=6.64,95%CI(1.29,34.29),P<0.05]、美国麻醉医师协会(American Society of Anesthesiologists,ASA)评分(>2分)[OR=2.72,95%CI(1.38,5.38),P<0.05]、尿失禁[OR=6.32,95%CI(3.40,11.76),P<0.05]、脑血管疾病[OR=5.73,95%CI(1.62,20.35),P<0.05],同种异体骨植骨[OR=3.02,95%CI(1.09,8.34),P<0.05]、手术时间(>3h)[OR=3.44,95%CI(1.92,6.13),P<0.05]、失血量(>1000ml)[OR=2.40,95%CI(1.73,4.77),P<0.05 ]、输血[OR=2.61,95%CI(1.36,5.01),P<0.05]、融合节段(>3个)[OR=2.23,95%CI(1.55,3.23),P<0.05]、没有预防性使用抗生素[OR=5.43,95%CI(2.66,11.08),P<0.05]、术中参观人员[OR=2.28,95%CI(1.19,4.37),P<0.05]。结论:男性、年龄>60岁、肥胖、糖尿病、感染史、ASA评分>2分、尿失禁、脑血管疾病、同种异体骨植骨、手术时间>3h、失血量>1000ml、输血、融合节段>3个、没有预防性使用抗生素、术中参观人员均为国人脊柱术后发生SSI的危险因素。 |
Meta-analysis of risk factors of surgical site infection in Chinese patients with spinal surgery |
英文关键词:Surgical site infection Spinal surgery Risk factors Meta-analysis |
英文摘要: |
【Abstracts】 Objectives: To comprehensively evaluate the risk factors of surgical site infection after spinal surgery, and to provide science basis for the management of surgical site infection in patients with spinal surgery. Methods: Electronic databases including PubMed(1966.1-2017.5), EMBASE(1974.1-2017.5), Cochrane Library(2017.5), CNKI(1994.1-2017.5), CBM(1979.1-2017.5), VIP(1989.1-2017.5) and Wanfang(1982.1-2017.5) were searched to identity studies that assessed the risk factors of surgical site infection in Chinese patients up to May 2017. Two authors independently conducted the search, extracted the data(including location, time of study, sample size, age, diagnosis, surgical type and exposure factors), and assessed the quality of included studies according to Newcastle-Ottawa Scale(NOS). RevMan 5.3 software was used for the statistical analysis. Results: Totally, 29 studies involving 18486 paties were included in this meta-analysis. Among these, 932 cases were assigned in infection group, while 17554 cases in control group. All articles were evaluated by NOS quality criterial and there were 19 papers graded as A, and 10 papers as grade B. The results of Meta-analysis showed that risk factors related to the surgical site infection in Chinese patients were sex(male)[OR=1.33, 95%CI(1.08, 1.64), P<0.05], age(>60)[OR=1.44, 95%CI(1.01, 2.04), P<0.05], obesity[OR=2.64, 95%CI(1.35, 5.15), P<0.05], diabetes[OR=3.86, 95%CI(2.68, 5.55), P<0.05], previous infection[OR=6.64, 95%CI (1.29, 34.29), P<0.05], ASA score(>2)[OR=2.72, 95%CI(1.38, 5.38), P<0.05], urinary incontinence[OR=6.32, 95%CI(3.40, 11.76), P<0.05], cerebrovascular disease[OR=5.73, 95%CI(1.62, 20.35), P<0.05], allogeneic bone graft[OR=3.02, 95%CI(1.09, 8.34), P<0.05], operation time(>3 hours)[OR=3.44, 95%CI(1.92, 6.13), P<0.05], blood loss(>1000ml)[OR=2.40, 95%CI(1.73, 4.77), P<0.05], transfusion[OR=2.61, 95%CI(1.36, 5.01), P<0.05], fusion level(>3)[OR=2.23, 95%CI(1.55, 3.23), P<0.05], not prophylactic antibiotic[OR=5.43, 95%CI(2.66, 11.08), P<0.05], surgical visitors[OR=2.28, 95%CI(1.19, 4.37), P<0.05]. Conclusions: Gender(male), age(over 60 years), obesity, diabetes mellitus, infection history, ASA score(over 2), urinary incontinence, cerebrovascular disease, allograft bone graft, operation time(more than 3 hours), blood loss(>1000ml), blood transfusion, fusion segments(>3), no prophylactic antibiotics and visitors are risk factors for SSI in Chinese population undergoing spinal surgery. |
投稿时间:2017-04-23 修订日期:2017-07-26 |
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