脑出血患者微创术后引流致颅内感染因素分析及防治  

Risk factors for intracranial infections caused by micro-invasive drainage for spontaneous cerebral hemorrhage and prevention measures

作　　者：陈炜毅[1] 陈光烈[1] 富壮[1] 

机构地区：[1]宁波市第二医院神经外科,浙江宁波315010

出　　处：《中华医院感染学杂志》2013年第17期4168-4170,共3页Chinese Journal of Nosocomiology

摘　　要：目的探讨脑出血微创术后外引流致颅内感染的相关因素分析，为进一步预防及治疗提供理论依据。方法回顾性分析2005年2月-2011年12月行微创穿刺外引流术治疗的260例患者临床资料。结果260例自发性脑出血行微创穿刺外引流术治疗患者，发生颅内感染30例，感染率11. 54% ;年龄在20-60岁的感染率为8.00%,〉60岁的感染率18. 00%，两者差异有统计学意义（P〈0. 05）;留置管时间〈5 d感染率6. 43%，留置管时间〉5 d感染率17. 50%，两者差异有统计学意义（P〈0. 05）;单管外引流感染率7. 06%，双管感染率20.00%,两者差异有统计学意义（P〈0. 01）;脑内血肿腔引流感染率5. 56%，脑室内引流感染率21. 43%，两者差异有统计学意义（P〈0. 01）;血肿腔注射尿激酶感染14. 86%，未注射尿激酶感染率4. 71%，两者差异有统计学意义（P〈0.05）;存在并发症的感染率20. 69%，无并发症的感染率6. 94%，两者差异有统计学意义（P〈0. 01）;拔管后有脑脊液漏的感染率26. 15%，无脑脊液漏的感染率6. 67%，两者差异有统计学意义（P〈0. 01 ）；GCS评分越低则感染率越高。结论随着微创手术的广泛应用，正确处理与分析术后的并发症显得特别重要，正确使用抗菌药物、尽可能缩短置管时间、正确放置引流袋、合理注射尿激酶及加强营养、预防其他并发症是预防感染的重要措施。OBJECTIVE To explore the risk factors of intracranial infections after micro-invasive drainage treatmentof the patients with spontaneous cerebral hemorrhage so as to provide theoretical bases for further prevention andtreatment. METHODS The clinical data of 260 patients treated with micro-invasive drainage from Feb 2005 to Dec2011 were retrospectively analyzed. RESULTS Of totally 260 cases of patients with spontaneous cerebral hemorrhage, 30 cases （11. 5%） of intracranial infection were found; the infection rate of the patients aged between 20and 60 years old was 8. 00% , the infection rate of the patients aged more than 60 years old 18. 00 %,the differencebetween the two group was significant （P〈0. 05） ;the patients with the duration of indwelling less than 5 days hada lower infection rate than did those with the duration of indwelling more than 5 days （6. 43% vs 17. 50%）,thedifference was significant （P〈0. 05） ; the patients using single catheter had a lower infection rate than did thoseusing dual catheters （7. 06% vs 20. 00%）,the difference was significant （P〈0. 01）; the infection rate of thepatients who underwent the intracerebral hematoma cavity drainage was 5. 56%,the patients who underwent theventricular drainage 21. 43%,the difference between the two groups was significant （P〈0. 01） ; the infection rateof the patients with the hematoma cavity injected with urokinase was 14. 86 %,the patients without being injectedwith urokinase 4.71%, the difference was significant （P〈0. 05） ; the infection rate of the patients with complications was 20. 69%,the patients without complication 6. 94% , the difference was significant （P〈0. 01） ; the infection rate of the patients with the leakage of cerebrospinal fluid after removal of the catheter was 26. 15%,the patients without the leakage of cerebrospinal fluid 6. 67% , the difference was significant （P〈0. 01）. In addition, the lower the GCS score, the greater the infection rate was. CONCLUSION With the widespread use

关 键 词：颅内出血 外科手术 微创性 术后并发症 

分 类 号：R181.32[医药卫生—流行病学]