神经外科幕上手术术后颅内感染的发生率及危险因素调查

A retrospective analysis of post-craniotomy intracranial infection in patients after supratentorial neurosurgical operation： incidence, risk factors and outcomes

目的 调查首都医科大学附属北京天坛医院神经外科幕上手术患者术后颅内感染的发生率、危险因素及转归.方法 选择2011年1月至2012年12月4 104例神经外科幕上手术患者.回顾性分析患者病例资料、实验室结果报告及影像学等信息,得出术后颅内感染的发生率、危险因素和转归.结果 神经外科幕上手术患者术后颅内感染的发生率为5.0％.预防性抗生素能够明显降低患者术后颅内感染发生率（OR ＜1,P＜0.05）.手术持续时间、术中输注红细胞、术后留置引流管和术后头部CT显示颅内出血为危险因素（OR ＜1,P＜0.05）.感染组患者较非感染组患者住院时间、住院花费差异有统计学意义（P＜0.05）.肺部感染发生率在感染组明显多于非感染组（P＜0.05）.结论 神经外科幕上手术患者术后颅内感染的发生率为5.0％,感染患者住院时间、花费明显增加,应当给予足够重视.预防性抗生素能够显著降低颅内感染发生率,应常规应用于神经外科幕上手术患者.

Objective To investigate the incidence,risk factors and outcomes of post-craniotomy intracranial infection （PCII） in patients after supratentorial neurosurgical operation in Beijing Tiantan Hospital.Methods Patients who underwent supratentorial neurosurgical operation in our hospital form January 1st,2011 to December 31st,2012 were included.The medical records,imaging findings,and laboratory data were reviewed to investigate the incidence,risk factors,and outcomes of patients of PCII.Results The incidence of PCII was 5.0%.Adiministration of prophylactic antibiotics reduced the incidence of PCII （odds ratio 〈 1,P 〈 0.05）.Operation time,red blood cell infusion,postoperative drainage tube placement,and intracranial hemorrhage were independent risk factors for PCII （odds ratio 〈 1,P 〉 0.05）.Patients with PCII had significantly longer hospital stay and higher hospital costs （P 〈 0.05）.The incidence of pneumonia was higher in patients with PCII （P 〈 0.05）.Conclusions The overall incidence of PCII in patients after supratentorial neurosurgical operation was 5.0%.Patients with PCII had longer hospital stay and higher hospital costs,which indicated that patients with PCII should be carefully managed.Prophylactic antibiotics should be considered for patients undergoing supratentorial neurosurgical operation.