颅脑损伤伴颅内感染患者的临床特点和急性期预后的影响因素  

Clinical features of traumatic brain injury with intracranial infection and the related factors for the prognosis in the acute phase

作　　者：刘小波[1] 林爱国[1] 何程[1] 唐宏图[1] 周鸿伟[1] 

机构地区：[1]四川遂宁市第一人民医院神经外科,遂宁629000

出　　处：《中国实用神经疾病杂志》2016年第7期15-17,共3页Chinese Journal of Practical Nervous Diseases

基　　金：四川省科技局计划项目(编号20140526N)

摘　　要：目的分析颅脑损伤后发生颅内感染患者的病原菌特点,探讨与急性期预后相关的影响因素。方法选取2011-04—2014-09在我院行颅脑手术的颅脑损伤患者300例,对术后发生颅内感染情况、病原菌的分布特点及影响急性期预后的相关因素进行分析。结果 300例颅脑损伤患者中发生颅内感染64例,感染率21.33%。其中年龄<12岁或>60岁、脑脊液漏、手术部位在幕下、手术时间>4h、未进行清洁手术、术后放置引流管>48h、脑室外引流>1周的患者感染率显著升高(P<0.05);术前抗生素的使用对颅内感染的发生影响不显著。脑脊液培养共分离出38株病原菌,其中鲍曼不动杆菌占主要部分,构成比26.32%,金黄色葡萄球菌次之,构成比18.42%。结论年龄<12岁或>60岁、脑脊液漏、手术部位在幕下、手术时间>4h、未进行清洁手术、术后放置引流管>48h、脑室外引流>1周是发生颅内感染及影响急性期预后的危险因素,手术过程中应尽量避免,以减少颅内感染的发生,改善急性期预后。Objective To analyze the ch-aracteristi＇es of pathogens in patients with intracranial infection after cranioeerebral injury,and to explore the influence factors of related to the prognosis in the acute phase. Methods Three hundred patients with traumatic brain injury from April 2011 to September 2014 in our hospital were selected,the postoperative intracranial infection occurrence, the distribution characteristics of pathogenic bacteria and related influencing factors affecting the prognosis in the acute phase were analyzed. Results Of the 300 patients with traumatic brain injury, 64 cases with intracranial infection,the positive rate was 21.33%. Patients with age less than 12 or more than 60 years old,cerebrospinal fluid leakage,infratentorial operation,operation time more than 4 hours, no clean surgery, tube placement time postoperative drainage more than 48 hours,intraventricular external drainage time more than one week had significant higher infection rate （P〈0.05）. Preoperative use of antimicrobial drugs had no significant affect on the occurrence of intracranial infection. A total of 38 strains of pathogenic bacteria were isolated,including Bowman＇s occupied the main part of acinetobacter composition ratio, accounting for 26.32 %, the second was Staphylococcus aureus,accounting for 18.42%. Conclusion Age less than 12 or more than 60 years old,ccrebrospinat fluid leakage,infratentorial operation, operation time more than 4 hours,no clean surgery, tube placement time postoperative drainage more than 48 hours,intraventricular external drainage time more than one week are the risk factors of intracranial infection and the prognosis in the acute phase,so these factors should be avoided during the operation,in order to reduce the occurrence of intracranial infection and improve the prognosis in the acute phase.

关 键 词：颅脑损伤 颅内感染 临床特点 预后 

分 类 号：R651.11[医药卫生—外科学]