患者开颅术后颅内感染相关因素调查  

Risk factors of intracranial infections after open craniotomy

作　　者：马艳芳[1] 陈亮[1] 侯伟丽[1] 高丽娜[1] 侯燕花 

机构地区：[1]安阳市人民医院重症监护室,河南安阳455000

出　　处：《中华医院感染学杂志》2016年第11期2485-2487,共3页Chinese Journal of Nosocomiology

基　　金：河南省科技厅基金资助项目(201308902CN)

摘　　要：目的探讨患者开颅术后颅内感染相关因素,为临床治疗提供参考依据。方法回顾性分析2013年1月-2015年8月100例开颅手术患者临床资料,分析其感染率及病原菌分布,筛选出影响颅内感染的相关因素,应用logistic回归分析进行多因素回归分析。结果 100例开颅手术患者中发生颅内感染22例,感染率22.0%;共分离出病原菌24株,其中革兰阴性菌16株占66.7%,革兰阳性菌8株占33.3%;鲍氏不动杆菌、铜绿假单胞菌对头孢噻肟、氨曲南、氨苄西林及左氧氟沙星的耐药率均>50.0%,金黄色葡萄球菌对氨苄西林、左氧氟沙星及红霉素的耐药率均>50.0%;有糖尿病史、发生脑脊液漏、放置引流管、植入异物及手术时间≥2h的患者感染率高,差异有统计学意义(P<0.05);logistics回归分析发现,糖尿病史、发生脑脊液漏、放置引流管、手术时间延长及白蛋白水平低下是影响患者开颅术后颅内感染发生的危险因素(P<0.05)。结论多种因素影响开颅术后颅内感染的发生,因此尽量缩短手术时间、严密缝合硬脑膜防止脑脊液漏、术前提高白蛋白水平等可能减少开颅术后颅内感染的发生。OBJECTIVE To study the risk factors of intracranial infections after open craniotomy,and to provide a reference for clinical treatment.METHODS The clinical data of 100 patients with open craniotomy from Jan.2013 to Aug.2015 were analyzed retrospectively.Infection rate and pathogen distribution were analyzed,and factors affecting intracranial infection were screened.Logistic regression analysis was used to analyze multiple factors.RESULTS Among the 100 patients,22of them underwent intracranial infection with the incidence of 22.0%.A total of 24 pathogens were isolated,including 16 strains of gram-negative bacteria（66.7%）,8strains of grampositive bacteria（33.3%）.Drug resistance rate of Acinetobacter baumannii,Pseudomonas aeruginosa to cefotaxime,aztreonam,ampicillin and levofloxacin were all higher than 50.0%.Drug resistance rate of Staphylococcus aureus to ampicillin,erythromycin and levofloxacin were all higher than 50.0%.Patients with diabetes history,cerebrospinal fluid leakage,placed drainage,tube implanted and operation time≥2hhad high infection rate,and the difference was significant（P〈0.05）.Logistics regression analysis found that the history of diabetes,cerebrospinal fluid leakage,drainage tube placement,prolong operation time and lower albumin levels were risk factors for postoperative intracranial infection（P〈0.05）.CONCLUSION Many factors affect the occurrence of intracranial infection after open craniotomy,so we had better shorten the operation time,closely suture dura to prevent cerebrospinal fluid leakage,and improve preoperative albumin level,reduce the occurrence of intracranial infections after open craniotomy.

关 键 词：开颅术 颅内感染 危险因素 

分 类 号：R651.11[医药卫生—外科学]