创伤性脑积水脑室-腹腔分流术后并发感染的危险因素分析  

Risk factors for postoperative infection in patients with post-traumatic hydrocephalus after ventriculoperitoneal shunt

作　　者：李光亮 王方艺 李良 张翼 LI Guang-liang;WANG Fang-yi;LI Liang;ZHANG Yi(Department of Neurosurgery,Dengzhou People's Hospital,Dengzhou 474150,China)

机构地区：[1]邓州市人民医院神经外科,河南474150

出　　处：《中国临床神经外科杂志》2023年第9期573-576,580,共5页Chinese Journal of Clinical Neurosurgery

摘　　要：目的探讨创伤性脑积水(PTH)病人脑室-腹腔分流术(VPS)后发生感染的危险因素。方法回顾性分析2015年5月至2020年5月VPS治疗的250例PTH的临床资料。术后随访1年,评估感染情况,包括VPS相关的颅内感染、切口感染、腹腔感染。采用多因素logistic回归模型分析术后感染的危险因素,并构建列线图模型,采用受试者工作特征(ROC)曲线评估模型的预测效能。结果术后随访1年,32例(12.8%)发生感染,其中8例脑室端感染,14例腹腔端感染,3例腹腔假性囊肿,7例感染后脑脊液蛋白及纤维素含量过高引起分流管阻塞;表皮葡萄球菌16例,金黄色葡萄球菌7例,革兰氏阴性菌6例,其他细菌3例;31例治愈,1例因其他疾病死亡。多因素logistic回归分析显示,年龄≥60岁(OR=0.366,95%CI 0.153~0.877,P=0.024)、合并糖尿病(OR=0.153,95%CI 0.053~0.445,P=0.001)、去骨瓣减压术(OR=0.213,95%CI 0.084~0.536,P=0.001)、分流管暴露时间≥30 min(OR=0.178,95%CI 0.071~0.446,P<0.001)是PTH病人VPS后出现感染的独立危险因素。根据这6个危险因素构建预测感染的列线图总分为330分,当分值>180分时,PTH病人VPS后感染的风险预测值>90%;ROC曲线分析显示列线图曲线下面积值显著高于单一指标(P<0.05)。结论高龄、糖尿病、去骨瓣减压术及分流管暴露时间长是PTH病人VPS后发生感染的高危因素,根据这些高危因素构建的列线图模型具有较好的预测价值,可为PTH病人VPS后感染的临床预判与治疗提供参考。Objective To investigate the risk factors of postoperative infection in patients with post-traumatic hydrocephalus(PTH)after ventriculoperitoneal shunt(VPS).Methods The clinical data of 250 patients with PTH treated with VPS from May 2015 to May 2020 were retrospectively analyzed.The patients were followed up for 1 year to evaluate the infection status,including VPS-related intracranial infection,incision infection,and abdominal infection.Multivariate logistic regression model was used to analyze the risk factors of postoperative infection,and a nomogram model was constructed.Receiver operating characteristic(ROC)curve was used to evaluate the predictive efficacy of the nomogram model.Results Of these 250 patients,32 patients(12.8%)suffered from postoperative infection,of which 8 patients were intraventricular infection,14 intraperitoneal infection,3 intraperitoneal pseudocysts,and 7 shunt tube obstruction caused by high levels of protein and cellulose in cerebrospinal fluid.Sixteen patients were infected with Staphylococcus epidermidis,7 with Staphylococcus aureus,6 with gram-negative bacteria,and 3 with other bacteria.Thirty-one patients were cured and one died of other diseases.Multivariate logistic regression analysis showed that age≥60 years(OR=0.366,95%CI 0.153~0.877,P=0.024),diabetes(OR=0.153,95%CI 0.053~0.445,P=0.001),decompressive craniotomy(OR=0.213,95%CI 0.084~0.536,P=0.001),shunt exposure time≥30 min(OR=0.178,95%CI 0.071~0.446,P<0.001)were independent risk factors for infection in PTH patients after VPS.A nomogram model was constructed based on these 6 risk factors,and the total score of the model for predicting infection was 330.When the score was>180,the risk of infection in PTH patients after VPS was>90%.ROC curve analysis showed that the area value under the curve of the model was significantly higher than that of any single risk factor(P<0.05).Conclusions Elder age,diabetes mellitus,decompressectomy and long shunt exposure time are high risk factors for infection in PTH patients after VPS.The

关 键 词：创伤性脑积水 脑室-腹腔分流术 术后感染 危险因素 列线图模型 

分 类 号：R651.1[医药卫生—外科学]