影响听神经鞘瘤术后颅内感染的因素分析

Infection factors for postoperative intracranial infections in patients undergoing acoustic neuroma resection

目的分析影响听神经鞘瘤术后颅内感染的危险因素,为临床预防和控制颅内感染提供依据。方法回顾性分析2007年2月至2015年2月于广东省第二人民医院就诊的305例听神经鞘瘤患者临床资料,并对发生感染的37例患者和未发生感染的268例患者临床资料、术后气管切开、手术情况、基础疾病、抗菌药物使用情况、激素使用情况等进行单因素和多因素Logistic回归分析。结果单因素分析结果显示,术后住院时间、年龄≥60岁、存在术后脑脊液漏、合并基础疾病、未使用抗菌药物、使用激素以及手术持续时间长患者发生感染现象多;采用多因素Logistic回归模型分析显示,术后脑脊液漏、合并有基础疾病、手术持续时间、使用激素等为听神经鞘瘤术后颅内感染的独立危险因素。37例颅内感染患者中共检出病原菌32株,其中革兰阴性菌18株,占56.25%;革兰阳性菌11例,占34.38%;真菌3株,占9.38%。结论影响听神经鞘瘤术后颅内感染因素主要有术后脑脊液漏、合并有基础疾病、手术持续时间、使用激素等,围术期应加强对上述因素的控制,以最大限度降低术后颅内感染现象发生。

Objective To evaluate the influence factors for postoperative intracranial infections in patients undergoing acoustic neuroma resection in order to provide the basis for clinical prevention and control of intracranial infection. Methods The clinical data were collected from 305 patients who received acoustic neuroma resection in our hospital from February 2007 to February 2015.37 cases with infection and 268 cases without infection.Univariate and multivariate Logistic regression were used to analyze the clinical data of patients,postoperative tracheotomy surgery,the underlying disease,the use of antibiotics and hormones. Results Univariate analysis showed that postoperative hospital stay,age≥60 years,the presence of postoperative cerebrospinal fluid leakage,the underlying disease,do not use of antimicrobial drugs,the use of hormones and the longer duration of surgery were all increase the chance of infection.Multi-factor Logistic regression analysis showed that postoperative cerebrospinal fluid leakage,associated with underlying diseases,surgery duration and use of hormones were the independent risk factors for intracranial infection. 32 pathogens were isolated from 37 cases of intracranial infection,including 18 Gramnegative bacteria,accounting for 56.25%,11 Gram-positive bacteria,accounting for 34.38 %,and 3 fungi,accounting for 9.38%. Conclusion The influencing factors of postoperative intracranial infection were the main postoperative cerebrospinal fluid leakage associated with the underlying disease,duration of surgery,and use of hormones. Perioperative management should be strengthened to control these factors and minimize postoperative intracranial infection.