重型颅脑损伤继发颅内感染的临床分析

Clinical analysis of intracranial infections following severe craniocerebral injury

目的探讨重型颅脑损伤继发颅内感染的临床特点,为临床治疗提供参考依据。方法回顾性分析2008年1月-2013年1月324例重型颅脑损伤患者的临床资料,调查继发颅内感染发生的各种因素,数据采取SPSS19.0进行统计。结果重型颅脑损伤继发颅内感染69例,发生率为21.30%,其感染与有脑脊液漏、进行脑室外引流、手术的部位、手术时间、清洁手术、术后放置引流管的时间以及脑室外引流的时间有关,组间资料比较,差异有统计学意义(P<0.05);重型颅脑损伤患者继发颅内感染病原菌培养主要以鲍氏不动杆菌和金黄色葡萄球菌为主,分别占27.50%、20.00%。结论重型颅脑损伤患者进行手术应防止脑脊液漏发生,正确处理污染区域,提高无菌操作观念,尽可能缩短手术的时间,加强引流管的护理,减少脑室外引流管放置,降低颅内感染的发生,改善患者的预后。

OBJECTIVE To explore the clinical characteristics of intracranial infections following severe craniocerebral injury so as to provide reference for clinical treatment. METHODS Clinical data of 324 patients with severe craniocerebral injury during Jan. 2008-Jan. 2013 were retrospectively analyzed. Various factors for secondary intracranial infection were statistically summarized with SPSS 19.0. RESULTS There were 69 cases of intracranial infections following severe craniocerebral injury, the incidence was 21.30%. The infection was related with cerebrospinal fluid leak, external ventricular drainage, surgery sites, surgery time, clean operation, postoperative drainage tube placement and external ventricular drainage time. The data comparison between groups showed the difference was significant （P〈0.05）. The pathogen culture for intracranial infections following severe craniocerebral injury showed the pathogens were mainly Acinetobacter baumannii （27. 50%） and Staphylococcus aureus （20.00%）. CONCLUSION For surgery in patients with severe craniocerebral injury, clinicians should prevent cerebrospinal fluid leakage, correctly handle the contaminated area, improve sterile operation concept, shorten the time of surgery as far as possible, strengthen the nursing of drainage tube, reduce placement of external ventricular drainage tube, so as to reduce the incidence of intracranial infection and improve the prognosis of patients.