重型颅脑损伤术后颅内感染、病原菌分布及其危险因素调查  

Analysis of postoperative intracranial infection,pathogen distribution,and risk factors in patients with severe traumatic brain injury

作　　者：肖玉平 孙际典 史今盛 崔啸天 XIAO Yuping;SUN Jidian;SHI Jinsheng;CUI Xiaotian(Beijing Tiantan Hospital,Capital Medical University,Beijing 100160,China;Beijing You'an Hospital,Capital Medical University;Beijing Anzhen Hospital,Capital Medical University)

机构地区：[1]首都医科大学附属北京天坛医院,北京100160 [2]首都医科大学附属北京佑安医院 [3]首都医科大学附属北京安贞医院

出　　处：《中国病原生物学杂志》2025年第5期602-605,共4页Journal of Pathogen Biology

摘　　要：目的调查重型颅脑损伤(SCI)术后颅内感染(ICI)情况及病原菌分布,并分析ICI发生的危险因素。方法回顾性分析2021年6月至2024年7月在本院行去骨瓣减压术(DC)的305例SCI患者的资料,根据术后有未发生ICI分成感染组和对照组。通过Logistic回归模型筛查SCI术后ICI发生的危险因素。结果305例患者术后ICI发生率为16.07%(49/305)。共分离出病原菌67株,其中革兰阳性菌构成比最高(58.21%),且主要为凝固酶阴性葡萄球菌(CNS)(31.34%)。感染组合并糖尿病情况、损伤类型、入院GCS评分、手术用时、脑脊液漏、术前Alb水平和对照组比较有统计学差异(P<0.05)。Logistic回归分析显示,合并糖尿病(OR=2.791,95%CI:1.517~5.134)、入院GCS评分为3~5分(OR=3.539,95%CI:1.977~6.334)、手术用时>6 h(OR=2.814,95%CI:1.482~5.342)、脑脊液漏(OR=2.731,95%CI:1.505~4.956)、术前Alb水平<35 g/L(OR=3.023,95%CI:1.621~5.638)为SCI术后ICI发生的危险因素。结论SCI患者术后ICI发生和合并糖尿病、入院GCS评分低、手术用时长、脑脊液漏、术前Alb水平低有关,感染病原菌以CNS为主。故应结合患者高危因素、病原菌分布开展针对性的防控,以保证患者术后安全性。Objective To investigate the incidence of intracranial infection(ICI)and pathogen distribution after severe craniocerebral injury(SCI)surgery,and analyze the risk factors for ICI occurrence.Methods A retrospective analysis was conducted on the data of 305 SCI patients who underwent decompressive craniectomy(DC)in our hospital from June 2021 to July 2024.The patients were grouped into an infection group and a control group based on whether ICI occurred after surgery.The logistic regression model was used to screen for risk factors for ICI occurrence after SCI surgery.Results The incidence of postoperative ICI in 305 patients was 16.07%(49/305).A total of 67 strains of pathogenic bacteria were isolated,with the highest proportion of Gram positive bacteria(58.21%),mainly coagulase negative Staphylococcus(CNS)(31.34%).There were obvious differences between the infection group and the control group in terms of combined diabetes,injury type,admission GCS score,operation time,cerebrospinal fluid leakage,preoperative Alb level(P<0.05).Logistic regression analysis showed that combined diabetes(OR=2.791,95%CI:1.517-5.134),admission GCS score of 3-5 points(OR=3.539,95%CI:1.977-6.334),operation time>6 hours(OR=2.814,95%CI:1.482-5.342),cerebrospinal fluid leakage(OR=2.731,95%CI:1.505-4.956),and preoperative Alb level<35 g/L(OR=3.023,95%CI:1.621-5.638)were the risk factors for postoperative ICI.Conclusion The incidence of postoperative ICI in SCI patients is related to combined diabetes,low admission GCS score,long operation time,cerebrospinal fluid leakage,and low preoperative Alb level.CNS is the main pathogen of infection.Therefore,targeted prevention and control should be carried out based on the high-risk factors of patients and the distribution of pathogens to ensure the safety of patients after surgery.

关 键 词：重型颅脑损伤 颅内感染 病原菌分布 危险因素 

分 类 号：R651.1[医药卫生—外科学]