老年腰椎间盘突出症术后并发手术部位感染的影响因素分析-现代医学

老年腰椎间盘突出症术后并发手术部位感染的影响因素分析

单位：1. 广元市第二人民医院康复科, 四川广元 628000;
2. 广元市第二人民医院呼吸内科, 四川广元 628000;
3. 广元市第一人民医院急诊科, 四川广元 628000

分类号：R496

出版年·卷·期（页码）：2025·53·第五期（815-820）

摘要：

目的： 探讨老年腰椎间盘突出症(LDH)术后并发手术部位感染(SSI)的影响因素。方法： 回顾性选取2020年2月至2024年8月LDH术后并发SSI的老年患者48例为SSI组，选取同期术后未并发感染的老年LDH患者106例为未感染组。收集老年LDH患者年龄、身体质量指数(BMI)、术前白蛋白(Alb)、术后第1天中性粒细胞与淋巴细胞比值(NLR)、术后第1天系统性免疫炎症指数(SII)等临床资料。Logistic回归分析老年LDH患者术后并发SSI的影响因素，据此构建列线图预测模型预测老年LDH患者术后SSI的发生风险，绘制校准曲线、受试者工作特征(ROC)曲线评估列线图预测模型的校准度、预测效能。结果： SSI组年龄、BMI、糖尿病占比、术中出血量、术后第1天NLR、术后第1天SII水平高于未感染组，术前Alb水平低于未感染组，手术时间长于未感染组(P＜0.05)。Logistic回归分析显示，高BMI(OR=1.518，95%CI 1.196～1.928)、糖尿病(OR=3.272，95%CI 1.468～7.294)、手术时间长(OR=1.033，95%CI 1.012～1.054)、高术后第1 天NLR(OR=3.334，95%CI 1.689～6.581)、高术后第1天SII(OR=1.009，95%CI 1.005～1.013)是老年LDH患者术后并发SSI的危险因素(P＜0.05)，高术前Alb(OR=0.867，95%CI 0.786～0.957)是老年LDH患者术后并发SSI的保护因素(P＜0.05)。据上述因素构建的列线图预测模型，H-L检验发现其具有良好的校准度，ROC曲线显示该模型曲线下面积(AUC)为0.953，灵敏度为79.17%，特异度为96.22%，预测效能良好。结论： BMI、糖尿病、术前Alb、手术时间、术后第1天NLR、术后第1天SII均可影响老年LDH患者术后SSI的发生，据此构建的列线图预测模型具有较好的一致性与预测价值，可为临床干预策略制定提供依据。

Objective: To investigate the influencing factors of surgical site infection(SSI) following lumbar disc herniation(LDH) surgery in elderly patients. Methods: 48 elderly LDH patients with postoperative SSI from February 2020 to August 2024 were retrospectively selected as SSI group, and 106 elderly LDH patients without postoperative infection were selected as uninfected group during the same period. Clinical data such as age, body mass index(BMI), preoperative albumin(Alb), neutrophil to lymphocyte ratio(NLR) on the 1st day after surgery, and systemic immune-inflammation index(SII) on the 1st day after surgery were collected in elderly LDH patients. Logistic regression analysis was conducted to analyze the influencing factors of postoperative SSI in elderly LDH patients, and a nomogram prediction model was constructed to predict the risk of postoperative SSI in elderly LDH patients. Calibration curve and receiver operating characteristic(ROC) curve were drawn to evaluate the calibration degree and prediction efficiency of the nomogram prediction model. Results: The levels of age, BMI, the prevalence rate of diabetes, intraoperative blood loss, NLR and SII at the 1st day after surgery in SSI group were higher than those in uninfected group, the level of Alb before surgery was lower than that in uninfected group, and the operative time was longer than that in uninfected group(P<0.05). Logistic regression analysis showed that high BMI(OR=1.518, 95%CI 1.196-1.928), diabetes(OR=3.272, 95%CI 1.468-7.294), long operation time(OR=1.033, 95%CI 1.012-1.054), high NLR on the first day after surgery(OR=3.334, 95%CI 1.689-6.581), high SII on the first day after surgery(OR=1.009, 95%CI 1.005-1.013) were risk factors for postoperative SSI in elderly LDH patients(P<0.05). High preoperative Alb(OR=0.867, 95%CI 0.786-0.957) was a protective factor for postoperative SSI in elderly LDH patients(P<0.05).H-L test found that the nomogram prediction model built by the above factors had a good calibration degree, and ROC curve showed that the area under the curve(AUC) of the model was 0.953, the sensitivity was 79.17%, the specificity was 96.22%, and the prediction efficiency was good. Conclusion: BMI, diabetes mellitus, Alb before surgery, time of operation, NLR on the first day after surgery, and SII on the first day after surgery can all affect the occurrence of postoperative SSI in elderly LDH patients. The prediction model based on this nomogram has good consistency and predictive value, and can provide a basis for the formulation of clinical intervention strategies.

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