重型颅脑创伤和重症高血压脑出血患者有创颅内压监测术后早期颅内感染及其危险因素  

Incidence of and Risk Factors for Early Intracranial Infection after Invasive Intracranial Pressure Monitoring for Severe Traumatic Brain Injury or Hypertensive Intracranial Hemorrhage

作　　者：秦梦阳 张文泰[1] 凌宇辉 李坤航 李立帅 于鸿业 赵丹[1] 王维[1] 杨华林[2] 孙晓伟[3] 包义君[1] QIN Mengyang;ZHANG Wentai;LING Yuhui;LI Kunhang;LI Lishuai;YU Hongye;ZHAO Dan;WANG Wei;YANG Hualin;SUN Xiaowei;BAO Yijun(Department of Neurosurgery,The First Hospital,China Medical University,Shenyang 110001,China;Department of Neurosurgery,Liaoning Provincial Corps Hospital,Chinese People’s Armed Police Forces,Shenyang 110034,China;Department of Neurosurgery,The Tenth Clinical College of China Medical University,General Mine Hospital of Fuxin,Fuxin 123000,China)

机构地区：[1]中国医科大学附属第一医院神经外科,沈阳110001 [2]武警辽宁总队医院神经外科,沈阳110034 [3]中国医科大学第十临床学院(阜新矿总医院)神经外科,辽宁阜新123000

出　　处：《中国医科大学学报》2019年第9期786-790,共5页Journal of China Medical University

基　　金：中国博士后科学基金面上资助项目(2016M590240);教育部留学回国人员科研启动基金(教外司留[2013]1792号);辽宁省自然科学基金(2015020460);沈阳市科技计划(17-230-9-13);中国医科大学附属第一医院科学研究基金(FSFH201722)

摘　　要：目的重型颅脑创伤和重症高血压脑出血患者具备有创颅内压监测指征,探讨有创颅内压监测术后早期颅内感染发生率及危险因素。方法对226例重型颅脑创伤和重症高血压脑出血患者进行回顾性分析,按术中有无有创颅内压监测分为监测组和传统手术组(对照组)。观察术后1周内早期颅内感染的发生情况,并对感染危险因素进行分析。结果监测组45例患者中,颅脑创伤30例,高血压脑出血15例;对照组181例患者中,颅脑创伤96例,高血压脑出血85例。术后1周内,监测组颅内感染7例(15.56%),其中颅脑创伤4例(8.89%),高血压脑出血3例(6.67%);对照组颅内感染30例(16.57%),其中颅脑创伤15例(8.29%),高血压脑出血15例(8.29%)。2组比较,术后早期颅内感染发生率无统计学差异(P>0.05)。颅底骨折、术后营养指标、术后间断开放脑室型外引流管是监测组发生术后早期颅内感染的危险因素(P<0.05),而术后间断开放脑室型外引流管是独立危险因素(P<0.05)。结论术后1周内,在重型颅脑创伤和高血压脑出血患者中有创颅内压监测与传统手术比较不会增加颅内感染的风险,术后尽可能规避间断开放脑室型外引流管,可以在一定程度上防止有创颅内压监测术后早期颅内感染的发生。Objective To investigate the incidence of and risk factors for early intracranial infection after invasive intracranial pressure monitoring in patients with severe traumatic brain injury or hypertensive intracranial hemorrhage.Methods A total of 226 patients with severe traumatic brain injury or hypertensive intracranial hemorrhage admitted to our department were retrospectively analyzed and divided into the monitoring group and the traditional operation group(control group),according to the presence or absence of invasive intracranial pressure monitoring.The incidence of and risk factors for early intracranial infection within 1 week after surgery were compared between the groups.Results Among 45 patients in the monitoring group,30 had traumatic brain injury and 15 had hypertensive intracranial hemorrhage.Among 181 patients in the control group,96 had traumatic brain injury and 85 had hypertensive intracranial hemorrhage.Within 1 week after surgery,intracranial infection occurred in 7 patients(15.56%)in the monitoring group and in 30 patients(16.57%)in the control group.There was no significant difference in the incidence of early intracranial infection between the two groups.Fracture of the skull base,postoperative nutritional index,and intermittent open ventricular drainage were risk factors for early intracranial infection in the monitoring group,and intermittent open ventricular drainage was an independent risk factor.Conclusion Invasive intracranial pressure monitoring does not increase the risk for intracranial infection within 1 week after severe traumatic brain injury or hypertensive intracranial hemorrhage compared with the traditional operation.Early intracranial infection can be prevented by avoiding intermittent open ventricular drainage.

关 键 词：有创颅内压监测 重型颅脑创伤 高血压脑出血 颅内感染 

分 类 号：R651.1[医药卫生—外科学]