神经内镜手术后颅内感染的调查与控制

Nerval endoscopic surgery postoperative infection investigate and control in neurosurgical unit

目的调查神经外科神经内镜手术后颅内感染的原因,控制颅内感染的发生。方法采用前瞻性与回顾性相结合的方法调查2006年1～6月神经内镜手术患者的病历资料,并对手术环境进行细菌学检测。结果共调查25例患者,其中1～4个月(采取控制措施前)17例,发生颅内感染6例,感染率为35.3%;5～6个月(采取控制措施后)8例,发生颅内感染1例,感染率为12.5%。对手术医师及手术环境进行采样,其中空调柜机及仪器表面检测出金黄色葡萄球菌;手术室空气细菌数平均为218CFU/m3;手术中无菌头皮夹培养出微球菌。手术操作现场观察发现神经内镜清洗不符合要求;外科洗手未按照手消毒产品的要求使用无菌毛巾擦手;无菌手术器械暴露在空气中的时间过长。结论手术环境、外科手消毒及神经内镜清洗等缺陷是造成神经内镜手术后颅内感染的综合原因。

[Objective] To investigate the reason of intracranial infection among the neurosurgical patients after endoscopic surgery, and to make the valid control measure and reduce the occurance of intracranial infection. [Methods] The epidemiology data of patients who received nerval endoscopic surgery was conducted by prospective and retrospective analysis from January to June in 2006. [Results] Among the 25 patients, there were 17 cases from January to April （before adopted control measures）, and 6 cases occurred intracranial infection, infection rate were 35.3%. 8 cases from May to June（after adopted control measures）, and only 1 case occurred intracranial infection, infection rate were 12.5%. Surgeon and operation environment were sampled. Staphylococcus aureus was detected on the surface of air condition and nerval endoscope. The average number of bacterias in operation room was 218 CFU/ m^3. Asepsis scalp clip used during the operation was cultivated Micrococcus. The washed of nerval endoscope didn＇t attain the requirement during the operation period. The surgeon didn＇t use asepsis towel according to the requirement of degerm production of hands in the operation. Aseptic surgical instruments were exposed in the air for a long time. [Conclusions] The reason of intracranial infection among the neurosurgical patients after endoscopic surgery were the degerm of operation circumstance and surgery hands didn＇t attain the requiremen, and the nerval endo- scope ablution wasn＇t thoroughly washed.