神经外科患者术后颅内感染相关危险因素分析

Analysis of the risk factors on neurosurgical postoperative intracranial infection

目的探讨与经鼻蝶窦入路内镜下垂体瘤切除术后颅内感染有关的危险因素。方法对88例经鼻蝶窦入路内镜下垂体瘤切除术患者资料进行回顾性分析,并对因经垂体瘤切除术后发生颅内感染的可能因素进行多因素Logistic回归分析。结果 88例患者中,术后感染9例,发生率为10.23%。其中手术持续时间大于7 h、术后发生脑脊液漏者、并发糖尿病者、术前应用激素、抗生素者、术后应用抗生素超过7 d者、入住危重病房(ICU)者、住院时间>3周者的感染率分别为18.75%、18.51%、16.67%、10.81%、11.42%、9.67%、27.27%、13.51%。经Logistic回归分析,手术持续时间、脑脊液漏和糖尿病是内镜下经鼻孔蝶窦入路切除垂体瘤术后颅内感染的主要影响因素,统计学意义差异(P<0.05);而术前是否应用激素、抗菌药物和术后应用抗菌药物时间均不是影响术后颅内感染的主要因素。结论经鼻蝶窦入路内镜下垂体瘤切除术后颅内感染与手术持续时间、脑脊液漏和糖尿病等有关,颅内感染应重点预防,同时提高细菌培养结果是治疗的关键。

Objective To explore the risk factors of transsphenoidal operation assisted by endoscope in resection of pi tuitary adenoma.Methods Retrospective analysis was applied to 88 cases of transsphenoidal operation assisted by en doscope in resection of pituitary adenoma and logistic regression analysis of the factors resulting in intracranial infec tion after the operation was carried out.Results In the 88 cases,postoperative infections had 9 cases,and the infection rate was 10.23%.Operation time more than 7 hours,there were cerebrospinal fluid leakage,diabetes,corticosteroids were the preoperative use of antibiotics,the use of antibiotics more than 7 days after operation,patients in ICU,and the length of hospital stay more than 3 weeks the infection rates were 18.75%,18.51%,16.67%,10.81%,11.42%,9.67%,27.27%,13.51%,respectively.Operation time,cerebrospinal fluid leakage,diabetes were the factors resulting in intracranial infection after transsphenoidal operation assisted by endoscope in resection of pituitary adenoma,in which there was a statistical difference（P〈0.05）,and preoperative corticosteroids,preoperative use of antibiotics,and postoperative antibiotics after the surgery complicated by infection had no obvious effect.Conclusion Intracranial infection after transsphenoidal operation assisted by endoscope in resection of pituitary adenoma is affected by factors of operation time,cerebrospinal fluid leakage,diabetes,and so forth.Much attention should be paid to intracranial infection prevention and improving the bacterial culture test was the key to the treatment.