神经外科手术患者切口感染相关因素的探讨

Related risk factors of incisional wound infection in patients under craniectomy

目的 探讨神经外科手术切口感染发生的高危因素,为切口感染的预防控制提供临床依据. 方法 选择福建医科大学附属第二医院神经外科自2011年1月至2013年12月发生术后切口感染的患者70例（感染组）,另随机选取同期手术未发生切口感染的70例患者作为对照（非感染组）.取感染切口的分泌物进行进行病原学检查;比较感染组和非感染组患者的临床资料,多因素Logistic回归分析感染组患者切口感染的独立危险因素. 结果 与非感染组比较,感染组患者的年龄较大、白蛋白水平和格拉斯哥昏迷评分（GCS）降低,血糖水平和急性生理及慢性健康状况评分（APACHEⅡ）增高,接台手术、手术时间＞4 h、使用显微镜、输血所占比例增加,差异有统计学意义（P＜0.05）;细菌培养显示感染患者中病原菌阳性72例（88.57％）.其中革兰阴性杆菌占45.71％,革兰阳性球菌占40.00％,真菌占2.86％;多因素Logistic回归分析显示白蛋白、血糖、手术时间＞4h、使用显微镜、输血、GCS评分、APACHEⅡ评分是神经外科手术切口感染的独立危险因素. 结论 影响神经外科手术切口感染的高危因素包括患者白蛋白、血糖情况及手术时间、术中应用显微镜、输血、GCS评分和APACHEⅡ评分,感染病原菌多为革兰阴性杆菌和革兰阳性球菌,合理有效的制定预防措施,可以减少术后切口感染的发生,改善患者预后.

Objective To investigate the risk factors of incisional wound infection and put forward prevention measures to control the incision infection in patients under craniectomy.Methods Seventy patients with infection and 70 without infection of incisional wound among 1756 patients undergoing craniectomy from January 2011 to December 2013 were chosen in our study;and their clinical data were retrospective analyzed;etiological examination was performed on the secreta of these patients;the high risk factors of incisional wound infection were analyzed using multivariable Logistic regression.Results As compared with those in the non-infection group,patients in the infection group had significantly older age,lower albumin and Glasgow coma scale （GCS） scores,higher blood glucose level and APACHE Ⅱ scores,and higher percentages of surgical access station,microscopy applications,duration of surgery〉4 h and blood transfusion （P〈0.05）.Pathogenic bacteria was positive in 88.57% patients （62/70）,including 45.71% gram negative bacilli,40.00 % gram positive coccus and 2.86% fungus.Multivariate Logistic regression analysis further showed that albumin,blood glucose,microscopy applications,duration of surgery〉4 h,blood transfusion,APACHE Ⅱ scores and GCS scores were significantly associated with incision infection,being the independent risk factors for incision infection.Conclusions To aim directly at the high-risk factors of incision wound infection,such as albumin,blood glucose,microscopy applications,duration of surgery,blood transfusion,APACHE Ⅱ and GCS,we should develop reasonable and effective preventive measures to reduce the incidence of incision infection and improve patient prognosis.