3D打印辅助微创治疗高血压脑出血颅内感染的影响因素及对策  

Influencing factors and countermeasures for intracranial infection after three -dimensional printing-assisted minimally invasive treatment for hypertensive intracerebral hemorrhage

作　　者：吴敏 田晓玲[1] 邱长云 张奇[1] 刘璐 朱婷婷 樊翠翠 许红梅[3] WU Min;TIAN Xiao-ling;QIU Chang-yun;ZHANG Qi;LIU Lu;ZHU Ting-ting;FAN Cui-cui;XU Hong-mei(Department of Neurosurgery,Binzhou Medical University Hospital,Binzhou 256603,China;Institute for Metabolic and Neuropsychiatric Disorders,Binzhou Medical University Hospital,Binzhou 256603,China;School of Nursing,Binzhou Medical University,Yantai 264003,China)

机构地区：[1]滨州医学院附属医院神经外科,山东滨州256603 [2]滨州医学院附属医院代谢与神经精神疾病研究所,山东滨州256603 [3]滨州医学院护理学院,山东烟台264003

出　　处：《中国感染控制杂志》2021年第7期626-631,共6页Chinese Journal of Infection Control

基　　金：山东省医药卫生科技发展计划基金资助项目(2019WS330)。

摘　　要：目的分析3D打印辅助微创治疗高血压脑出血(HICH)术后颅内感染的影响因素,并探讨相应的预防对策,为术后颅内感染防控措施的制定提供依据。方法回顾性分析2015年10月—2018年12月某综合三级甲等医院神经外科行3D打印辅助微创治疗HICH患者的临床资料(n=324),依据是否发生颅内感染分为感染组与非感染组,比较两组患者的一般资料、手术治疗过程等差异。结果324例3D打印辅助微创治疗HICH患者,发生颅内感染32例,感染率为9.87%。颅内感染患者送检标本检出病原菌19株,其中革兰阴性菌9株(47.37%),革兰阳性菌8株(42.10%),真菌2株(10.53%)。3D打印辅助微创治疗HICH患者单因素分析结果显示,吸烟史、颅内出血量、术前备皮距手术时间、手术地点、手术持续时间、术后溶凝治疗次数、引流管留置时间、预防性使用抗菌药物8项因素比较,差异具有统计学意义(均P<0.05);多因素logistic回归分析结果显示,预防性应用抗菌药物为预防颅内感染的保护性因素,而颅内出血量、术前备皮距手术时间、手术持续时间,引流管留置时间是发生颅内感染的独立危险因素。结论3D打印辅助微创治疗HICH患者术后发生颅内感染是多种因素共同作用的结果,在围手术期重要环节采取有效的防控措施,是预防颅内感染的关键。Objective To analyze the influencing factors for post-operative intracranial infection after three-dimensional printing-assisted minimally invasive(3DP-MI)treatment for hypertensive intracerebral hemorrhage(HICH),explore the corresponding preventive measures,so as to provide basis for the formulation of prevention and control measures of post-operative intracranial infection.Methods Clinical data of 324 patients who underwent 3DP-MI treatment in neurosurgery department of a tertiary hospital from October 2015 to December 2018 were retrospectively analyzed,according to whether intracranial infection occurred,patients were divided into infection group and non-infection group,general information and surgical treatment course of two groups of patients were compared.Results Among 324 patients undergoing 3DP-MI treatment,32(9.87%)had intracranial infection.19 strains of pathogens were isolated from specimens of patients with intracranial infection,including 9 strains(47.37%)of Gram-negative bacteria,8 strains(42.10%)of Gram-positive bacteria,and 2 strains(10.53%)of fungi.Univariate analysis on HICH patients undergoing 3DP-MI treatment showed that differences in smoking history,intracranial hemorrhage volume,time from pre-operative skin preparation to operation,operation location,operation duration,times of post-operative thrombolytic therapy,indwelling time of drainage tube,and prophylactic use of antimicrobial agents were all significantly different(all P<0.05);multivariate logistic regression analysis showed that prophylactic use of antimicrobial agents was the protective factor for the prevention of intracranial infection,while intracranial hemorrhage volume,time from pre-operative skin preparation to operation,operation duration,indwelling time of drainage tube were independent risk factors for intracranial infection.Conclusion Post-operative intracranial infection in HICH patients undergoing 3DP-MI treatment results from a variety of factors,the key to the prevention of intracranial infection is to take effective

关 键 词：3D打印技术 微创治疗 高血压脑出血 颅内感染 影响因素 

分 类 号：R181.32[医药卫生—流行病学]