神经外科术后颅内感染相关因素分析与预防对策

Risk Factors and Preventive Therapeutic Strategies on Intracranial Infection after Craniotomy

目的探讨神经外科术后颅内感染相关因素,提出预防措施。方法回顾分析1613例神经外科开颅手术中64例颅内感染病例,对影响感染率的各项因素行2χ检验。结果感染率与脑室外引流、留置引流管时间、二次手术、脑脊液漏、后颅凹入路、手术显微镜应用、手术时间>4 h、是否清洁手术有关,与性别、年龄、手术季节、术前应用抗菌药物、是否急诊手术无关。结论神经外科手术应严密缝合手术切口防止脑脊液漏,正确处理污染区域,提高无菌观念,缩短手术时间,加强引流管护理,尽早拔除引流管,减少放置引流管,特别是脑室外引流管等,可降低颅内感染率。

OBJECTIVE To study the risk factors and preventive therapeutic strategies of neurosurgical postoperative intracranial infection. METHODS Totally 1613 patients who had a neurosurgical operation from Jan 2005 to Jun 2008 in our department were chosen （64 cases with intracranial infection）. The infection rate was 3.97 %. The risk factors were studied retrospectively,X^2 test was selected to analyze the factors which might cause infection. RESULTS The analysis of 1613 cases revealed that infection rate was closely related to ventricular drainage, long indwelling drainage, emergency subsequent surgery postcraniotomy, CSF leakage, the approach to the post fossa, surgical microscopy, operation time above 4 h and polluted operation; while had no significonce of sex, age, the season, application of antibiotics before the operation and emergency operation. CONCLUSIONS To decrease the infection rate, the suture should be complete to prevent CSF leakage, polluted region be cleaned effectively, strict asepticly technique be measured, the operation be finished as soon as possible, drainage be prevented from pollution carefully and the duration of the drainage be controlled strictly, especially to the ventricular drainage.