国内颅脑损伤术后颅内感染危险因素的Meta分析  

Meta Analysis of Risk Factors for Intracranial Infection after Craniocerebral Injury in China

作　　者：王昆鹏[1] 王维兴[1] 杨婕[1] 呼铁民[1] 闫丽娜[1] WANG Kunpeng;WANG Weixing;YANG Jie(The Affiliated Hospital of Chengde Medical College,Hebei Chengde 067000,China)

机构地区：[1]承德医学院附属医院,河北承德067000

出　　处：《河北医学》2018年第9期1527-1532,共6页Hebei Medicine

基　　金：2016年度河北省医学科学研究重点课题计划指令性课题;(编号:20160013)

摘　　要：目的:探讨颅脑损伤术后颅内感染的危险因素,为临床治疗及预防提供理论依据。方法:检索中国知网、维普、万方、CBM及Pub Med数据库,检索自各数据库建立始至2016年7月国内公开发表的颅脑损伤术后颅内感染的相关危险因素的病例对照研究,运用固定或随机模型对各危险因素进行定量综合分析。结果:共纳入14项病例对照研究,7969例研究对象。Meta分析结果示:年龄≥45岁[OR合并=1.49,95%CI(1.14~1.94),P=0.003]、术前GCS评分<8分[OR合并=2.53,95%CI(1.09~5.84),P=0.037]、血白蛋白<35g/L[OR合并=3.56,95%CI(1.27~9.96),P=0.02]、手术时间>4h[OR合并=3.47,95%CI(1.96~6.13),P<0.0001]、放置脑室外引流[OR合并=1.93,95%CI(1.00~3.72),P<0.00001]、存在脑脊液漏[OR合并=5.15,95%CI(2.17~12.24),P=0.0002]和手术次数>1次[OR合并=6.38,95%CI(2.72~14.97),P<0.0001]等因素均为颅脑损伤术后颅内感染的危险因素,差异均有统计学意义(P<0.05)。开放性颅脑损伤[OR合并=1.02,95%CI(0.50~2.11),P=0.95]、血糖≥7mmol/L[OR合并=3.25,95%CI(0.49~21.31),P=0.22]等因素对颅内感染的影响差异无统计学意义(P>0.05)。结论:患者年龄>45岁、术前GCS<8分、血白蛋白<35g/L、手术时间>4h、放置脑室外引流、存在脑脊液漏及手术次数>1次均为颅脑损伤术后颅内感染的高危险因素。指导临床对高危患者进行积极有效的预防和治疗,以降低病死率和改善预后。Objective： To explore risk factors for intracranial infection after craniocerebral injury surgery,and provided the theory basis for clinical treatment and prevention. Methods： The Chinese knowledge network,VIP,Wan Fang,CBM,and Pub Med database were retrieved,and a case-control study on the related risk factors of intracranial infection after craniocerebral injury in China was retrieved from the establishment of each database to July 2016. The quantitative and comprehensive analysis of the risk factors was carried out by a fixed or random model. Results： A total of 14 case-control studies,7969 patients had been brought into study. Meta analysis results showed that： ≥45 years old[OR_（the combine OR）= 1.49,95% CI（ 1.14 ~ 1. 94）,P = 0.003],preoperative GCS8 [OR_（the combine OR）= 2.53,95% CI（ 1. 09 ~ 5. 84）,P = 0. 037],serum albumin 35 g/L[OR_（the combine OR）= 3.56,95%CI（ 1.27 ~ 9.96）,P = 0.02],operation time4 hours [OR_（the combine OR）= 3.47,95%CI（ 1.96~6.13）,P0.0001],external ventricular drainage [OR_（the combine OR）= 1.93,95% CI（ 1.00 ~ 3.72）,P 0.00001],cerebrospinal fluid leakage [OR_（the combine OR）= 5.15,95%CI（ 2.17 ~ 12.24）,P = 0.0002] and operation more than once were all risk factors for intracranial infection after craniocerebral injury surgery,the difference has statistically significance（ P〈0.05）. The influence factor of open craniocerebral injury [OR_（the combine OR）= 1.02,95%CI（ 0.50 ~ 2.11）,P = 0.95],blood glucose≥7 mmol/L [OR_（the combine OR）= 3.25,95%CI（ 0.49 ~ 21.31）,P = 0.22] has no statistically significance（ P〈0.05）. Conclusion： The age was≥45 years old,GCS8,ALB35 g/L,operation time 4 hours,external ventricular drainage,cerebrospinal fluid leakage,operation more than once were high risk factors for intracranial infection after craniocerebral injury surgery. Positive prevention and treatment should be carried on the clinical guidance for high-risk patients to reduce mortality and improve prognosis.

关 键 词：颅脑损伤 颅内感染 危险因素 

分 类 号：R651.15[医药卫生—外科学]