CAJ | 학술논문

目的探讨短时间预防性使用抗生素对颈椎术后伤口感染的影响.方法回顾性分析2009至2011年行择期颈椎手术的患者965例,根据使用抗生素的种类及时间分为短时间使用预防性抗生素组(A组234例)和经验性使用预防性抗生素组(B组731例).收集患者一般资料、内科合并疾病病史、手术相关信息、患者围手术期体温及相关检验数据、抗生素使用情况,并收集伤口感染患者资料.结果 A组使用二代头孢菌素153例、克林霉素81例,抗生素使用时间(1.2±0.4)d.B组使用青霉素类41例、二代头孢菌素375例、三代头孢菌素2例、克林霉素128例、头霉素类42例、喹诺酮类128例、其他1例、联合用药14例,抗生素使用时间(5.7±1.6)d.抗生素使用时间的差异有统计学意义(P ＜0.001).A、B两组在手术前后白细胞计数差异无统计学意义,术后中性类细胞分类A组70.7％±9.7％,B组67.1％±9.8％,P =0.004,差异有统计学意义,但均在正常参考范围之内,无临床意义.术后伤口感染共7例(0.7％),A组4例(1.7％),B组3例(0.4％),均为颈后路椎管扩大成型术患者,Fisher精确概率法P=0.063,差异无统计学意义.结论对于颈椎手术患者,短时间合理使用预防性抗生素并未增加术后伤口感染的机会.
목적 탐토단시간예방성사용항생소대경추술후상구감염적영향.방법 회고성분석2009지2011년행택기경추수술적환자965례,근거사용항생소적충류급시간분위단시간사용예방성항생소조(A조234례)화경험성사용예방성항생소조(B조731례).수집환자일반자료、내과합병질병병사、수술상관신식、환자위수술기체온급상관검험수거、항생소사용정황,병수집상구감염환자자료.결과 A조사용이대두포균소153례、극림매소81례,항생소사용시간(1.2±0.4)d.B조사용청매소류41례、이대두포균소375례、삼대두포균소2례、극림매소128례、두매소류42례、규낙동류128례、기타1례、연합용약14례,항생소사용시간(5.7±1.6)d.항생소사용시간적차이유통계학의의(P ＜0.001).A、B량조재수술전후백세포계수차이무통계학의의,술후중성류세포분류A조70.7％±9.7％,B조67.1％±9.8％,P =0.004,차이유통계학의의,단균재정상삼고범위지내,무림상의의.술후상구감염공7례(0.7％),A조4례(1.7％),B조3례(0.4％),균위경후로추관확대성형술환자,Fisher정학개솔법P=0.063,차이무통계학의의.결론 대우경추수술환자,단시간합리사용예방성항생소병미증가술후상구감염적궤회.
Objectives This study is designed to determine the impact of the short-time usage of prophylactic antibiotics to prevent postoperative wound infection in spinal surgery.Methods The medical records of 965 patients who underwent cervical spinal operation between 2009 and 2011 were collected for the assessment.These patients were divided into two groups based on antibiotic selection and duration of prophylactic antibiotic treatment:234 patients treated with prophylactic antibiotics for a short period of time were set as Group A,whereas Group B included 731 patients treated with prophylactic antibiotics for experience-based length of time.All the patients' records,including personal information,preoperational medical records,surgical records,postoperative medical information and the development of surgical site infections,were collected for analysis.Results In Group A,153 patients were treated by second generation cephalosporins and 81 patients were treated by clindamycin.The duration of treatment was 1.17 ± 0.38days.In Group B,41 patients were treated by penicillin,375 and 2 patients were treated by second and third generation cephalosporins,respectively,128 patients were treated by clindamycin,42 patients were treated by cephamycin,128 patients were treated by quinolone,other antibiotic was used by 1 patient and other 14 patients were treated by combinations of antibiotics.The duration of the treatment in Group B was 5.72 ±1.63 days.The significant differences between the length of treatment time in Group A and B were observed (P ＜ 0.001).There were no statistical differences of pre-/post-operational leukocytes number compared between Group A and B.In addition,although the neutrophils in Group A and B are 70.70％ ±9.71％ and 67.09％ ± 9.78％ respectively,indicating a subtle difference (t =2.921,P =0.004),however,these numbers were in normal range; therefore,no clinical significance was found from the comparison of neutrophils in groups.A total of 7 cases (0.73％) of surgical site infection were recorded,including 4 cases (1,71％) in Group A and 3 cases (0.41％) in Group B,all of which were posterior laminoplasty.With Fisher analysis (P =0.063),these infection rates were not statistically significant.Conclusions An appropriate usage of prophylactic antibiotics in a short period of time in cervical spinal surgery did not increase the rate of surgical site infection.