神经外科幕上手术术后颅内感染危险因素与预防措施

目的探讨神经外科幕上手术术后颅内感染病原茵特点、危险因素及其预防措施分析，为临床降低颅内感染提供依据。方法回顾性分析2012年3月至2015年2月718例行神经外科幕上手术治疗患者的临床资料，分析术后颅内感染病原菌特点，Logistical归分析感染的危险因素。结果718例神经外科患者术后发生颅内感染44例，感染率6．13％；送检标本中共检出病原茵63株，革兰阴性菌、阳性茵分别为40株（63．49％）、23株（36．51％）；单因素分析发现年龄≥60岁、原发疾病（脑肿瘤、脑血管疾病）、急诊手术、GCS评分〈9、APACHEⅡ评分〉15、术后住院时间〉10d、手术时间≥4h、手术次数≥2次、气管插管、输血、术后CT示颅内出血、留置引流管、激素使用、预防性应用抗菌药物、合并基础疾病是患者术后发生颅内感染的危险因素（P〈0．05）；多因素logistic归分析发现年龄≥60岁、手术次数≥2次、手术时间≥4h、气管插管、输血、术后CT示颅内出血、预防性应用抗菌药物是患者术后发生颅内感染的独立危险因素（P〈0．05）。结论神经外科幕上手术术后颅内感染病原茵较广，感染危险因素较多，需采取相应措施，可考虑预防性应用抗茵药物，以降低术后颅内感染率。

Objective This aim was to explore the infection pathogens characteristics, risk factors and preventive measures ofpost-craniotomy intracranial infection （ PCII ） in patients after neurosurgical operation, in order to provide basis for reducing intracranial infection rate. Methods A total of 718 patients who routine neurosurgical surgery from March 2012 to February 2015 in our hospital were selected, and their clinical data were retrospective analyzed. The characteristics of postoperative intracranial infection pathogens were analyzed. The risk factors for infection were analyzed by logistic regression analysis. Results 44 patients got intracranial infection among 718 neurosurgical patients, and the incidence of PCII was 6.13%. 63 plants pathogens were detected in submission samples, including gram-negative bacteria, gram-positive bacteria of 40, 23 plants, which accounting for 63.49%, 36.51%. Univariate analysis showed that age ≥60 years, primary disease （brain tumors, cerebrovascular disease ） , emergency surgery, GCS score〈9, APACHE II score〉 15, postoperative hospital stay〉 10d, the operation time ≥4h, the number of operations≥2, endotracheal intubation, transfusion, postoperative CT showed intracranial hemorrhage, indwelling drainage tube, hormone use, prophylactic use of antimicrobial drugs, combined with underlying disease were risk factors of PCII in patients after neurosurgical operation. Multivariate logistic regression analysis showed that age≥60 years, the number of operations≥ 2, the operation time ≥4h, endotracheal intubation, transfusion, postoperative CT showedintracranialhemorrhage, prophylactic use ofantibiotics was independent risk factors ofPCII in patients after neurosurgical operation （P〈0.05） . Coueluslons The results show that the pathogens of PCII are broader, risk factors of PCII in patients after neurosurgical operation are vicious, it＇ s need to take appropriate measures, consider prophylactic use of antibiotics to reduce postoperative intracranial infection.