创伤性颅脑损伤患者颅内感染影响因素分析及干预措施  

Risk factors analysis and interventions for traumatic brain injury patients complicated with intracranial infection

作　　者：张小燕 张培华 胡成旺[1] 时丽娜[1] ZHANG Xiao-yan;ZHANG Pei-hua;HU Cheng-wang;SHI Li-na(First Affiliated Hospital of Nanyang Medical College,Nanyang,Henan 473,000,China)

机构地区：[1]南阳医学高等专科学校第一附属医院神经外科,河南南阳473000 [2]南阳理工学院张仲景国医国药学院,河南南阳473000

出　　处：《中华医院感染学杂志》2018年第23期3594-3597,共4页Chinese Journal of Nosocomiology

基　　金：河南省科研计划基金资助项目(152102310025)

摘　　要：目的分析创伤性颅脑损伤(TBI)并发颅内感染(ICI)影响因素及患者临床干预体会。方法回顾性分析2015年6月-2017年6月于医院接受治疗的TBI患者203例,记录患者临床资料,以ICI诊断准则作为评价标准,分析患者年龄、性别、外引流、脑脊液漏及使用抗菌药物等临床资料,根据干预方式将患者分为对照组113例与干预组90例,对照组进行常规护理,干预组在常规护理基础上进行前期康复干预,观察两组患者干预前后患者神经功能恢复、认知、精神、运动和生活质量评分改善状况。结果 203例手术患者术后有14例并发ICI,感染率为6.90%;多因素Logistic回归分析结果显示,外引流和脑脊液漏为TBI并发ICI患者的影响因素(P<0.05);干预后,干预组患者躯体功能、社会功能、情感状况和健康感觉得分均高于对照组患者(P<0.05);干预组患者神经功能总有效率为93.33%,高于对照组患者的74.34%(χ2=6.082,P=0.003);干预后,两组患者LOTCA、MMSE和Fugl-Meyer评分均较治疗前升高,且干预组效果更佳(P<0.05)。结论外置引路管和脑脊液漏患者更易发生ICI,对患者前期进行护理干预可有效改善其认知、运动功能,恢复神经功能,提升患者生活质量。OBJECTIVE To analyze the risk factors of traumatic brain injury(TBI)complicated with intracranial infection(ICI)and the clinical intervention experience.METHODS A total of 203 TBI patients treated in the hospital from Jun.2015 to Jun.2017 were retrospectively analyzed,and the clinical data of the patients were recorded.Using the ICI diagnostic criteria as the evaluation criteria,the effects of age and gender of patients,external drainage of cerebrospinal fluid leakage,and use of antibiotics were analyzed.The patients were divided in to the control group with 113 cases and the intervention group with 90 cases based on the intervention method.The control group received routine nursing intervention,whereas the intervention group was given early rehabilitation intervention in addition to routine nursing.The recovery of neurological function,and the improvement of cognitive,mental,motor function and the scores of quality of life were observed before and after the intervention.RESULTS In 203 patients,14 patients had ICI after operation,and the infection rate was 6.90%.Multivariate logistic regression analysis showed that external drainage and cerebrospinal fluid leakage were the influencing factors of TBI complicated with ICI(P<0.05).After intervention,the physical function,social function,emotional status and health sensation scores of the intervention group were all significantly higher than those of the control group(P<0.05).The total effective rate of neurological function in the intervention group was 93.33%,which was significantly higher than that in the control group(74.34%)(χ2=6.082,P=0.003).The scores of LOTCA,MMSE and Fugl-Meyer after intervention were significantly higher than those before treatment in both groups,and the intervention group worked better(P<0.05).CONCLUSION Patients with external catheter and cerebrospinal fluid leakage are more likely to develop ICI.Early intervention can effectively improve their cognitive and motor function,restore neurological function,and improve the quality of life of

关 键 词：颅脑损伤 颅内感染 影响因素 前期护理干预 

分 类 号：R641[医药卫生—外科学]