经鼻颅底手术患者术中鼻腔细菌培养及临床分析  

Bacterial culture and its clinical analysis of patients undergoing transnasal skull base surgery

作　　者：张小荣[1] 郭秀英 张琳娟[1] 梅娜[1] 李瑞春[2] 冒平[2] 高珂[2] 宋莉[1] ZHANG Xiaorong;GUO Xiuying;ZHANG Linjuan;MEI Na;LI Ruichun;MAO Ping;GAO Ke;SONG Li(Department of Anesthesiology and Perioperative Medicine,The First Affiliated Hospital of Xi’an Jiaotong University;Department of Neurosurgery,The first Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710061,China)

机构地区：[1]西安交通大学第一附属医院麻醉手术部,陕西西安710061 [2]西安交通大学第一附属医院神经外科,陕西西安710061

出　　处：《西安交通大学学报（医学版）》2024年第4期645-649,共5页Journal of Xi’an Jiaotong University（Medical Sciences）

基　　金：陕西省自然科学基础研究计划项目(No.2023-JC-YB-720)。

摘　　要：目的 分析临床经鼻颅底手术术区细菌存留情况及其与术后颅内感染的相关性。方法 将经鼻颅底肿瘤(蝶鞍区及鞍上)切除术患者的手术过程分为鼻腔通道准备(第1阶段)、肿瘤切除(第2阶段)和颅底重建(第3阶段)3个阶段,在每个阶段的起始时点,于蝶窦前壁或鞍底斜坡隐窝处黏膜各取样1次进行细菌培养,分析手术不同阶段细菌培养阳性率及其与术后颅内感染的相关性。结果 共纳入患者105例,共取样315例次,3个阶段取样的中位时间点分别为手术开始后20.3、45.1、131.3 min。细菌培养的阳性结果第1阶段、第2阶段、第3阶段分别为9例(2.9%)、8例(2.5%)、23例(7.3%),其中第1阶段或第2阶段与第3阶段阳性例数差异均有统计学意义(P=0.013;P=0.007),而第1阶段与第2阶段差异无统计学意义(P=0.955)。共检出表皮葡萄球菌24例,金黄色葡萄球菌7例,溶血性链球菌3例,肺炎克雷伯杆菌2例,大肠杆菌4例。3阶段至少1次阳性结果的有36例(11.4%),术后17例(16.2%)脑脊液漏,12例(11.4%)颅内感染。细菌培养阳性患者发生颅内感染的危险性是阴性患者的3.1倍(OR=3.1,95%CI:0.9~10.6),但差异尚无统计学意义;脑脊液漏患者发生颅内感染的危险性是非脑脊液漏的61.4倍(OR=61.4,95%CI:11.2~337.1),差异有统计学意义(P<0.001)。术区鼻腔和术后脑脊液培养结果的菌种一致率为57.1%。结论 经鼻颅底手术术区细菌培养阳性率随手术时间延长而明显增高,是术后颅内感染的潜在风险指标。Objective To analyze the status of the bacteria in the operative area of transnasal skull base surgery and its correlation with postoperative intracranial infection.Methods The procedure of transnasal skull base surgery was divided into three stages:nasal passage preparation(stage 1),tumor resection(stage 2),and skull base reconstruction(stage 3).Bacterial sampling was taken from the mucosa of the anterior wall of sphenoid sinus or clival recess of sellar floor at the beginning of each stage;and the positive rate of bacterial culture in different stages of operation and its correlation with postoperative intracranial infection were analyzed.Results A total of 105 patients were enrolled in this study,and 315 samples were taken.The average time point of sampling in the three stages was 20.3,45.1 and 131.3 min after the beginning of operation,respectively.The positive results were 9 cases(2.9%)in the stage 1,8 cases(2.5%)in the stage 2,and 23 cases(7.3%)in the stage 3,which were 24 cases of Staphylococcus epidermidis,7 cases of Staphylococcus aureus,3 cases of hemolytic streptococcus,2 cases of Klebsiella pneumonia,and 4 cases of Escherichia coli.There was no significant difference in the positive cases between stage 1 and stage 2(P=0.955),but there were significant differences between stage 1 or 2 and stage 3(P=0.013;P=0.007).There were 36(11.4%)patients with at least one positive result in the three stages,17(16.2%)with cerebrospinal fluid leakage,and 12(11.4%)with intracranial infection.The risk of intracranial infection was 3.1 times higher in patients with positive bacterial culture than patients with negative bacterial culture(OR=3.1,95%CI:0.9-10.6),which was not statistically significant;patients with CSF leakage were 61.4 times higher t han those without CSF leakage(OR=61.4,95%CI:11.2-337.1),which was statistically significant(P<0.001).The consistency rate of bacteria in nasal cavity and postoperative cerebrospinal fluid culture was 57.1%.Conclusion The positive rate of bacterial culture in the operative are

关 键 词：内镜经鼻入路 细菌培养 颅内感染 消毒 

分 类 号：R651.1[医药卫生—外科学]