微血管减压术后并发无菌性脑膜炎的危险因素分析

Risk factors of aseptic meningitis after microvascular decompression

目的 探讨微血管减压术(MVD)后发生无菌性脑膜炎(AM)的危险因素,为临床预防MVD术后AM的发生提供参考.方法 回顾性分析解放军空军特色医学中心神经外科自2014年1月至2016年12月行MVD治疗的三叉神经痛或面肌痉挛的141例患者的临床资料,采用单因素及多因素Logistic回归分析模型对可能导致AM发生的18项相关因素进行统计分析.结果 单因素分析显示:性别、年龄、糖尿病、手术时间、术者熟练程度、术中使用地塞米松及术后换药时间等7种因素是MVD术后发生AM的相关因素(P<0.05);多因素Logistic回归分析显示男性(OR=2.920,P=0.015)、糖尿病(OR=0.200,P=0.026)及术中未使用地塞米松(OR=7.970,P=0.002)是术后发生AM的独立危险因素.结论 男性或糖尿病患者MVD术后发生AM概率较高,需注意防治;在MVD操作时,减压完成后于桥小脑角池内注入地塞米松,可以有效降低AM的发生率.

Objective To explore the risk factors of aseptic meningitis (AM) after microvascular decompression (MVD) to provide evidence for preventing the occurrence of AM. Methods One hundred and forty-one patients diagnosed as having trigeminal neuralgia or hemifacial spasm, admitted to our hospital from January 2014 to December 2016, were chosen. A retrospective analysis was performed on these clinical data. Eighteen related factors of AM were analyzed by Logistic regression model. Results The result of single analysis of related factors showed that gender, age, diabetes, operation time, skill level of the operator, injection of dexamethasone, and postoperative dressing time were related to AM after MVD (P<0.05). Multifactor Logistic regression analysis showed that gender (OR=2.920, P=0.015), diabetes (OR=0.200, P=0.026), and non-injection of dexamethasone (OR=7.970, P=0.002) were independent risk factors of postoperative AM. Conclusion The male or diabetic patients have high rate of postoperative AM; and the risk of postoperative AM would be reduced if we inject dexamethasone to the cerebellopontine angle cistern at the end of MVD.