神经外科手术部位感染及抗生素耐药因素研究  

Risk factors for postoperative neurosurgical site infections and antibiotic resistance

作　　者：保肇实[1] 游赣[1] 江涛[1] 

机构地区：[1]首都医科大学附属北京天坛医院神经外科,100050

出　　处：《中华脑科疾病与康复杂志（电子版）》2011年第1期19-23,共5页Chinese Journal of Brain Diseases and Rehabilitation（Electronic Edition）

基　　金：国家重点基础研究发展计划(2011CB707804);北京市科技计划首都临床特色应用研究项目资助(D101100050010007)

摘　　要：目的探讨神经外科手术部位感染相关因素及抗生素耐药因素分析。方法 (1)患者选择:回顾2009年2至5月北京天坛医院第十一病区病例81份,排除单纯化疗患者1例,选择行开颅入路手术治疗患者80例。(2)收集病例:根据病历记录,查阅、收集患者基本信息。(3)神经外科术后手术部位感染相关因素分析:将年龄、性别、手术耗时、病变部位、是否应用头部引流、病理结果、术中是否应用地塞米松、术中是否输血8项因素列为相关危险因素分析项目,应用Logistic回归分析相关关系。(4)神经外科术后手术部位感染患者抗生素耐药性相关危险因素分析:分析项目同感染相关因素分析,应用Logistic回归分析相关关系。结果手术耗时与术中应用头部引流与神经外科手术部位感染的相关危险度分别为3.407与0.395,P值分别为0.031、0.027;输血情况与神经外科术后手术部位感染后抗生素耐药的相关危险度为5.000,P值为0.083。结论保证手术质量,减少手术耗时,充分引流,早期应用引流装置,可预防术后手术部位感染的发生。明确输血指征,避免不必要的输血行为,可减少抗生素耐药的发生。Objective To evaluate incidence and risk factors of postoperative neurosurgical site infections and antibiotic resistance, in a series of 80 consecutive craniotomies. Methods Postoperative neurosurgical site infections were individualized from the No. eleven ward, Tiantan hospital＇s database of infections after craniotomy. According to the medical records, 8 factors, such as age, gender, duration of surgery, diseased region, external drainage, pathology results, using dexamethasone, and transfusion were studied by multivariate analysis. Results Independent risk factors of postoperative neurosurgical site infections were surgery duration and external drainage （ P = 0.031, 0.027 ）. Transfusion was not independent but relevant factor of postoperative neurosurgical site infec- tions （ P = 0. 083 ）. Conclusions It is advisable to reduce the duration of surgery and apply early external drainage for preventing postoperative neurosurgical site infections. Meanwhile, avoiding unnecessary transfusion may decrease the incidence of antibiotic resistance.

关 键 词：手术部位感染 抗生素耐药 危险因素 预防 

分 类 号：R651[医药卫生—外科学]