颅脑手术两种不同备皮方法的实验研究

Experimental Research of Two Different Methods of Skin Preparation in Neurosurgical Operation

目的探讨颅脑手术改良备皮方法的可行性。方法对163例神经外科择期颅脑手术患者按住院时间顺序分为实验组和对照组。对照组手术日采用局部清洁和术野推毛备皮法（保留0.2～0.3cm毛根）;实验组则在此基础上采用2次备皮刷头法：即麻醉后再行一次性备皮刀剃除发根,灭菌软毛刷蘸清洗剂刷洗头皮,无菌生理盐水冲洗头皮后擦干;分别对两组于消毒前、后在手术部位取样做细菌培养,统计术后切口感染率。结果 2组患者消毒前、后皮肤细菌分离率的差异无统计学意义。分离的细菌中凝固酶阴性葡萄球菌占56.41%,其中耐甲氧西林凝固酶阴性葡萄球菌检出率22.73%;肠球菌、枸橼酸杆菌、鲍曼不动杆菌各检出1株,药敏结果为敏感细菌,未检出金黄色葡萄球菌。实验组术后颅内感染率与对照组比较差异有统计学意义（P〈0.05）。结论采用术前2次备皮及软毛刷刷洗头皮并不能降低手术切口感染率,反而增加术后中枢神经系统感染的风险,而术前清洁和术野推毛备皮法具有操作简便、安全可行的优点。

Objective To explore the feasibility of the improved neurosurgical skin preparation method.Methods 163 patients with brain surgery were divided into experimental and control groups by hospitalized duration.Before operation,In the control group,the skin of surgical field was cleaned by local scalp and electric razors to remove the hair（20～30）mm hair root remained）.The experimental group were subjected to secondary brush method,shaving the hair root with disposable knife after anesthesia,scrubing the scalps with sterile soft brush dipped in cleaning agents,and drying scalp after washing with sterile saline.The skin swab samples were cultured before and after disinfection.Surgical site infection rates were counted.Results Positive rate of culture in the two groups of patients before and after disinfection showed no significant difference.The isolated staphylococcus sp.showed a negative coagulase,accounting for 56.41%,among them 22.73% were found to be methicillin-resistant coagulase-negative staphylococci.one strain of enterococcus,one citrobacter,and one acinetobacter baumannii were detected,respectively.All of the bacteria were antibiotics sensitive.No staphylococcus aureus was isolated.Intracranial infection rate after neurosurgery between the experimental and control groups was significantly different（P〈0.05）.Conclusion Secondary skin preparation before surgery and a soft brush to clean the scalp would not be able to reduce surgical infection,and inversely,increased risk of postoperative wound infection.Preoperative cleaning and razor shaving are simple,safe and feasible.