颅脑术后并发细菌性脑膜炎79例回顾性分析  

Postoperative bacterial meningitis in intracranial neurosurgery： a retrospective analysis of 79 cases

作　　者：陈晨[1] 徐婷[2] 邹鹤娟[2] 张文宏[1] 翁心华[1] 陈澍[1] 

机构地区：[1]复旦大学附属华山医院感染科,上海200040 [2]复旦大学附属华山医院院内感染管理科,上海200040

出　　处：《中华传染病杂志》2012年第5期273-277,共5页Chinese Journal of Infectious Diseases

基　　金：基金项目：上海市科学技术委员会科研计划资助项目（114119b1900）

摘　　要：目的了解颅脑术后细菌性脑膜炎的发病率，常见的感染病原体以及相关危险因素。方法对复旦大学附属华山医院2008年间所有神经外科出院病例行等距离整群抽样，查阅其中接受至少一次颅脑手术的病例资料。统计学处理采用x。检验及Logistic回归分析。结果共抽取1165例病例，其中术后细菌性脑膜炎79例，占6．78％；仅有8例细菌培养阳性，分别为鲍曼不动杆菌3株，鲁氏不动杆菌、肺炎克雷伯菌、表皮葡萄球菌、粪肠球菌、中间链球菌各1株；术后细菌性脑膜炎发生率较高的病种依次为神经鞘瘤、胶质瘤、脑积水，分别为15．85％（13／82）、12．21％（21／172）和10．34％（3／29）；Logistic逐步回归分析（从高到低）显示男性、植入物、胃肠内营养、脑室外引流及伤口负压引流是导致术后细菌性脑膜炎的独立危险因素。结论颅脑术后中枢神经系统感染仍是常见而严重的手术并发症，提高病原检出率、加强具有高危因素手术患者的感染预防尤为重要。Objective To investigate the incidence of bacterial meningitis in patients who underwent intracranial neurosurgery and to explore the pathogen distribution and related risk factors. Methods The patients were selected by cluster systematic sampling method from the patient population who underwent intraeranial neurosurgery for at least one time in Huashan Hospital affiliated to Fudan University in 2008. Chi-square test and Logistic regression model were used to analyze the data. Results A total of 1165 patients were included in this study. Seventy-nine of them were diagnosed with bacterial meningitis, while eight of them had positive results for bacterial culture, including 3 cases of Acinetobacter baumannii, and 1 case each of Acinetobacter lvaoffii, Klebsiella pneumoniae, Staphylococcus epidermidis, Enterococcus and Streptococcus intermedius. The common neurosurgical diseases with high incidence of postoperative bacterial meningitis were neurilemmoma 15. 85% （13/82）, glioma 12.21% （21/172） and hydrocephalus 10. 34% （3/29）. Logistic regression analysis identified male, implant, enteral nutrition, external ventricular drainage and wound negative pressure drainage as independent risk factors for postoperative bacterial meningitis. Conclusions Postoperative central nervous system infection is the most common and severe complication after the intracranial neurosurgery. The results highlight the importance of improving pathogen detection rate and enhancing the prevention in high risk patient populations.

关 键 词：脑膜炎 细菌性 脑 神经外科手术 手术后并发症 

分 类 号：R651.1[医药卫生—外科学]