脊柱手术全过程干预对预防患者切口感染的效果分析

Effect of comprehensive interventions on prevention of incision infections in patients undergoing spinal surgery

  • 摘要: 目的 探讨脊柱手术术后患者发生切口感染的相关因素及采取综合干预措施后对降低术后切口感染发生率的临床效果。方法 选取2016年5月-2017年5月医院1109例行脊柱手术患者作为对照组,对患者发生术后切口感染情况及相关因素进行分析,提出干预措施; 选取2017年6月-2018年6月该院1273例行脊柱手术患者作为试验组,实施干预措施,观察患者干预措施执行效果、手术切口感染发生率、平均住院时间及住院费用。结果 脊柱手术术后患者发生切口感染的主要相关因素为术前皮肤清洁、使用内固定材料或明胶海绵、引流置管; 试验组术前洗必泰擦浴执行率、接台手术术间自净时间不少于30 min执行率、引流置管24h内拔管执行率均有所提高,术中倒刺线、明胶海绵使用率、预防给药不合理率有所下降(P<0.05); 试验组术后切口感染率为0.79%(10/1273)低于对照组的2.07%(23/1109),两组比较差异有统计学意义(χ2=7.201,P=0.007),试验组患者住院时间(13.01±8.57)d短于对照组的(14.87±10.45)d,住院费用(2.37±1.27)万元少于对照组的(2.94±1.64)万元,两组比较差异有统计学意义(χ2=4.764,9.706,P<0.001)。结论 针对脊柱手术术后切口感染相关因素,采取精准的干预措施,可以降低术后切口感染率,同时可以缩短患者的住院时间、减少住院费用。

     

    Abstract: OBJECTIVE To explore the related factors for postoperative incision infections in patients undergoing spinal surgery and observe the effect of comprehensive interventions on reduction of incidence of the postoperative incision infections. METHODS Totally 1109 patients who underwent the spinal surgery in the hospital from May 2016 to May 2017 were assigned as the control group, the incidence of the postoperative incision infections and the related factors were analyzed, the intervention measures were put forward.Totally 1273 patients who received the spinal surgery in the hospital from Jun 2017 to Jun 2018 were chosen as the experimental group, and the intervention measures were carried out.The effects of the intervention measures, incidence of surgical incision infection, average length of hospital stay and hospitalization costs were observed. RESULTS The major related factors for the postoperative incision infections in the patients undergoing the spinal surgery included preoperative skin cleaning, internal fixation material or gelatin sponge and drainage tube.The rate of preoperative implementation of chlorhexidine rubbing bath, rate of implementation of self-purification time no less than 30 min and rate of implementation of removal of drainage tube within 24 hours were increased in the experimental group, while the utilization rates of intraoperative SPR, gelatin sponge and rate of unreasonable prophylactic use of antibiotics were significantly decreased (P<0.05).The incidence rate of postoperative incision infection of the experimental group was 0.79%(10/1273), significantly lower than 2.07%(23/1109) of the control group(χ2=7.201,P=0.007).The length of hospital stay of the experimental group was (13.01±8.57)days, significantly shorter than (14.87±10.45)days of the control group; the hospitalization cost of the experimental group was (2.37±1.27)ten thousand yuan, significantly less than (2.94±1.64)ten thousand yuan of the control group(χ2=4.764,9.706,P<0.001). CONCLUSION It is an effective way to take targeted intervention measures according to the related factors for the postoperative incision infections in the patients undergoing the spinal surgery so as to reduce the incidence of postoperative incision infections, shorten the length of hospital stay and cut the hospitalization cost.

     

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