脊柱术后切口引流管引流液培养的意义

Significance of drainage culture before removal of drainage tube in spinal surgery

摘要:

[目的] 分析脊柱外科手术患者术后切口引流管引流液培养的意义。[方法] 2019 年9 月—2024 年9 月本院行脊柱开放手术933 例患者纳入本研究，于拔除引流管时，切口引流管引流液进行细菌培养。记录细菌培养结果，并按临床相关指标分层比较分析。[结果] 933 例患者中培养阳性89 例，共分离97 株病原菌，其中49 株革兰阳性菌，47 株革兰阴性菌，1 株真菌感染。分层比较表明：按手术部位分层培养阳性率由高至低依次是，颈椎后路＞胸椎＞腰椎＞颈椎前路，差异有统计学意义（P＜0.05）；手术时间≥4 h 者培养阳性率显著高于手术时间＜4 h 者（11.7% vs 6.8%, P=0.013），炎性指标升高者的培养阳性率显著高于炎性指标未升高者（23.1% vs 7.3%, P＜0.001），切口渗液者的培养阳性率显著高于无切口渗液者（15.2% vs 7.5%, P＜0.001）。但是，糖尿病者与非糖尿病者的培养阳性率差异无统计学意义（7.3% vs 10.2%, P=0.220）。[结论] 脊柱外科术后切口引流管培养结果对术后伤口深部感染存在一定的预判作用，但需提高采样技术，减少假阳性结果。

Abstract:

[Objective] To analyze the significance of drainage culture before removal of drainage tube in spinal surgery. [Methods]From September 2019 to September 2024, 933 patients who underwent open spinal surgery in our hospital were included in this study. Be-fore the drainage tube was removed, the drainage fluid of the incision drainage tube was harvested for bacteria culture. The results of bacteri-al culture were recorded and compared according to clinical indicators. [Results] Of the 933 patients, 89 were positive with 97 pathogenicstrains isolated, including 49 gram-positive strains, 47 gram-negative strains and 1 fungal strain. As results of stratified comparison, the pos-itive rate according to the surgical site was ranked from high to low as, posterior cervical ＞ thoracic ＞ lumbar ＞ anterior cervical, with a statis-tical significance (P＜0.05). The positive rate of culture in patients with operation time ≥4 h was significantly higher than that in patients withoperation time ＜4 h (11.7% vs 6.8%, P=0.013), and the positive rate of culture in patients with increased inflammatory indexes was signifi-cantly higher than that in patients without increased inflammatory indexes (23.1% vs 7.3%, P＜0.001). The positive rate of culture in patientswith incision exudate was significantly higher than that in those without incision exudate (15.2% vs 7.5%, P＜0.001). However, there was nosignificant difference in culture positive rate between diabetic and non-diabetic patients (7.3% vs 10.2%, P=0.220). [Conclusion] The re-sults of incision drainage culture in spinal surgery have a certain predictive role on postoperative wound deep infection, but the samplingtechnique should be improved to reduce false positive results.