颅脑手术患者术后发生手术部位感染危险因素的Meta分析  

Risk Factors of Postoperative Surgical Site Infection in Patients Undergoing Craniocerebral Surgery:a Meta-analysis

作　　者：梁新慧 张珊 张腊婷 胡梦依 贾瑶 刘芳 姜雪 LIANG Xinhui;ZHANG Shan;ZHANG Lating;HU Mengyi;JIA Yao;LIU Fang;JIANG Xue(School of Nursing,Shaanxi University of Chinese Medicine,Xianyang 712046,China;Department of Neurosurgery,the Second Affiliated Hospital of Air Force Medical University,Xi'an 710038,China;School of Nursing,Air Force Medical University,Xi'an 710032,China)

机构地区：[1]陕西中医药大学护理学院,陕西省咸阳市712046 [2]空军军医大学第二附属医院神经外科,陕西省西安市710038 [3]中国人民解放军空军军医大学护理系,陕西省西安市710032

出　　处：《实用心脑肺血管病杂志》2024年第6期90-97,102,共9页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

基　　金：军队护理创新与培育专项计划创新项目(2021HL041);2023年空军军医大学第二附属医院护理新技术新业务资助项目(院护[2023]1号)。

摘　　要：目的系统评价颅脑手术患者术后发生手术部位感染的危险因素。方法计算机检索PubMed、Embase、Cochrane Library、Web of Science、中国生物医学文献数据库、中国知网、万方数据知识服务平台、维普网中关于颅脑手术患者术后发生手术部位感染危险因素的研究。检索时限为建库至2023年10月。提取纳入文献的资料,采用RevMan 5.3和Stata 15.0软件进行Meta分析。结果共纳入41篇文献,共60673例颅脑手术患者。Meta分析结果显示,颅脑手术患者术后手术部位感染发生率为8.4%〔95%CI(6.8%~10.1%)〕。术前住院时间>3 d〔OR=2.96,95%CI(1.68~5.22),P<0.01〕、合并糖尿病〔OR=3.26,95%CI(2.62~4.05),P<0.01〕、备皮时间>2 h〔OR=3.40,95%CI(2.07~5.58),P<0.01〕、美国麻醉医师协会(ASA)分级>Ⅱ级〔OR=3.75,95%CI(1.40~10.04),P<0.01〕、二次手术〔OR=3.67,95%CI(2.64~5.11),P<0.01〕、急诊手术〔OR=2.49,95%CI(1.75~3.52),P<0.01〕、手术持续时间延长〔OR=1.22,95%CI(0.15~2.28),P=0.03〕、手术持续时间>3 h〔OR=2.60,95%CI(1.61~4.21),P<0.01〕、手术持续时间>4 h〔OR=2.26,95%CI(1.41~3.62),P<0.01〕、污染切口〔OR=3.36,95%CI(1.19~9.48),P=0.02〕、手术切口数量>2个〔OR=3.82,95%CI(1.60~9.14),P<0.01〕、硬脑膜切开〔OR=4.02,95%CI(2.90~5.59),P<0.01〕、术中输血〔OR=4.27,95%CI(1.32~13.82),P=0.02〕、术中植入物〔OR=3.28,95%CI(2.42~4.45),P<0.01〕、脑脊液漏〔OR=20.38,95%CI(13.60~30.55),P<0.01〕、脑室外引流〔OR=6.60,95%CI(3.48~12.49),P<0.01〕、留置引流管〔OR=5.75,95%CI(1.04~31.70),P=0.04〕、留置引流管时间>3 d〔OR=2.43,95%CI(1.44~4.09),P<0.01〕、留置引流管时间>4 d〔OR=1.97,95%CI(1.34~2.89),P<0.01〕是颅脑手术患者术后发生手术部位感染的危险因素。结论现有证据表明,术前住院时间>3 d、合并糖尿病、备皮时间>2 h、ASA分级>Ⅱ级、二次手术、急诊手术、手术持续时间延长、手术持续时间>3 h、手术持续时间>4 h、污染切口、手术切�Objective To systematically evaluate the risk factors of postoperative surgical site infection in patients undergoing craniocerebral surgery.Methods Databases including PubMed,Embase,Cochrane Library,Web of Science,CBM,CNKI,Wanfang Data,VIP were retrieved to search for studies on the risk factors of postoperative surgical site infection in patients undergoing craniocerebral surgery.The search period was from inception to October 2023.The data of the included literature was extracted,RevMan 5.3 and Stata 15.0 were used for meta-analysis.Results A total of 41 articles were included,and involving 60673 patients undergoing craniocerebral surgery.Meta-analysis results showed that postoperative surgical site infection incidence rate in patients undergoing craniocerebral surgery was 8.4%[95%CI(6.8%-10.1%)].Preoperative hospital stay>3 d[OR=2.96,95%CI(1.68-5.22),P<0.01],diabetes[OR=3.26,95%CI(2.62-4.05),P<0.01],skin preparation time>2 h[OR=3.40,95%CI(2.07-5.58),P<0.01],American Society of Aneshesiologists(ASA)classification>Ⅱ[OR=3.75,95%CI(1.40-10.04),P<0.01],second operation[OR=3.67,95%CI(2.64-5.11),P<0.01],emergency surgery[OR=2.49,95%CI(1.75-3.52),P<0.01],prolonged operation time[OR=1.22,95%CI(0.15-2.28),P=0.03],operation time>3 h[OR=2.60,95%CI(1.61-4.21),P<0.01],operation time>4 h[OR=2.26,95%CI(1.41-3.62),P<0.01],contaminated incision[OR=3.36,95%CI(1.19-9.48),P=0.02],number of surgical incision>2[OR=3.82,95%CI(1.60-9.14),P<0.01],dural incision[OR=4.02,95%CI(2.90-5.59),P<0.01],intraoperative blood transfusion[OR=4.27,95%CI(1.32-13.82),P=0.02],intraoperative implants[OR=3.28,95%CI(2.42-4.45),P<0.01],cerebrospinal fluid leakage[OR=20.38,95%CI(13.60-30.55),P<0.01],external ventricular drainage[OR=6.60,95%CI(3.48-12.49),P<0.01],insert drainage tube[OR=5.75,95%CI(1.04-31.70),P=0.04],insert drainage tube time>3 d[OR=2.43,95%CI(1.44-4.09),P<0.01],insert drainage tube time>4 d[OR=1.97,95%CI(1.34-2.89),P<0.01]were the risk factors of postoperative surgical site infection in patients undergoing craniocerebral surgery.Conclusi

关 键 词：神经外科手术 外科伤口感染 危险因素 META分析 

分 类 号：R651[医药卫生—外科学]