郎明磊

[摘要] 目的 探討脊柱椎弓根螺钉复位内固定术后患者医院感染临床特征及治疗方法。 方法 选择2010年5月～2014年5月胜利油田中心医院收治的80例脊柱椎弓根螺钉复位内固定术后发生医院感染患者，按照随机数字表法分为观察组和对照组，每组各40例。对照组采用常规治疗方法，观察组在对照组基础上静脉滴注免疫球蛋白，统计医院感染部位、病原菌种类，比较两组患者临床疗效、住院治疗时间、抗菌药物使用总时间、导管留置时间；分别于治疗前、治疗后1、3、5 d监测两组患者红细胞沉降率（ESR）、白细胞计数（WBC）、C-反应蛋白（CRP）水平。 结果 80例术后医院感染患者，手术切口感染33例，占41.25%；上呼吸道系统感染21例，占26.25%；皮肤软组织感染11例，占13.75%。80例患者分离出197株病原菌，其中革兰阳性菌125株，占63.5%；革兰阴性菌68株，占34.5%；真菌4株，占2.0%。观察组住院时间、抗菌药物使用时间、导管留置时间显著少于对照组（P < 0.05），观察组总有效率为95.00%，对照组为80.0%，观察组总有效率显著高于对照组，差异有统计学意义（P < 0.05）。与治疗前比较，两组患者治疗1、3、5 d后ESR、WBC、CRP均显著降低，差异有统计学意义（P < 0.05）；治疗后各时段观察组ESR、WBC、CRP显著低于对照组，差异有统计学意义（P < 0.05）。 结论 脊柱椎弓根螺钉复位内固定术后患者医院感染病原菌主要是革兰阳性菌，联合免疫球蛋白能够缩短抗菌药物使用时间和住院时间，提高临床疗效，值得临床推广。

[关键词] 椎弓根螺钉；脊柱外科手术；医院感染；免疫球蛋白

[中图分类号] R687.3 [文献标识码] A [文章编号] 1673-7210（2016）02（c）-0103-04

Clinical characteristics and treatment method of nosocomial infection after internal fixation of spinal pedicle screw

LANG Minglei

Department of Spine Surgery， Shengli Oilfield Center Hospital， Shandong Province， Dongying 257034， China

[Abstract] Objective To explore the clinical characteristics and treatment method of nosocomial infection after internal fixation of spinal pedicle screw. Methods From May 2012 to May 2014， in Shengli Oilfield Center Hospital， 80 nosocomial infection patients after internal fixation of spinal pedicle screw surgery were selected and divided into observation group and control group according to random number table， with 40 cases in each group. Control group were treated with conventional treatment， the observation group based on the control group intravenous infusion of immunoglobulin， the site of nosocomial infection and the species of pathogenic bacteria were statistical analyzed， the clinical effect， hospitalization treatment time， antibacterial drugs total time，catheter indwelling time， ESR， WBC and CRP levels in two groups before and after treatment were compared. Results In 80 cases of nosocomial infection patients， incision infection were 33 cases， accounted for 41.25%； upper respiratory system infection were 21 cases， accounted for 26.25%； skin and soft tissue infections were 11 cases， accounted for 13.75%. 197 strains of pathogenic bacteria were isolated from 80 patients， gram positive bacteria were 125 strains， accounted for 63.5%； gram negative bacteria were 68 strains， accounted for 34.5%， 4 fungal strains accounted for 2%. Hospitalization time， antimicrobial drug use time， catheter indwelling time of observation group were significantly lower than those of the control group （P < 0.05）， observation group total effective rate was 95.00%， control group was 80.0%， the total effective rate in the observation group was significantly higher than that of the control group， the difference was statistically significant （P < 0.05）. ESR， WBC and CRP of patients in two group decreased significantly after treatment 1， 3， 5 d， the differences were statistically significant （P < 0.05）， and ESR， WBC， CRP of observation group in each period were significantly lower than those of the control group， the differences were statistically significant （P < 0.05）. Conclusion The nosocomial infection of spinal pedicle screw internal fixation patients pathogens are mainly gram positive bacteria，combination with immunoglobulin can shorten the time of antibiotics using and hospitalization time， improve the clinical efficacy， and be worth clinical promotion.

[Key words] Pedicle screw； Spinal surgery； Nosocomial infection； Immune globulin

随着脊柱外科技术的不断发展，术后感染的发生率也呈上升趋势。研究显示[1]术后感染是影响患者预后的独立危险因素，一旦感染，极大提高手术失败风险。此外手术后患者对病原菌的抵抗力降低，导致术后发生感染风险更高。本研究对医院行脊柱椎弓根螺钉复位内固定术患者临床资料进行汇总，分析术后医院感染患者临床特征；并针对感染的患者在常规治疗基础上联用人免疫球蛋白，旨在为脊柱椎弓根螺钉复位内固定术后感染的预防、治疗提供参考，现将研究成果总结如下。……