微创穿刺治疗高血压脑出血患者术后颅内感染的高危因素与感染预防研究

High risk factors for postoperative intracranial infections in hypertensive cerebral hemorrhage patients receiving minimally invasive treatment and prevention measures

目的分析微创穿刺治疗高血压脑出血患者术后颅内感染的高危因素,提出有效的预防策略,以提高疗效。方法选取2013年1月-2015年1月于医院接受微创穿刺手术后并发颅内感染的高血压脑出血患者36例为研究对象,采用回顾式调查分析方法对患者的临床资料进行分析,观察手术过程中首次出血清除量及微创穿刺针数对患者颅内感染率的影响,分析诱发术后颅内感染的高危因素及病原菌类型;采用SPSS18.0软件进行统计分析。结果患者手术过程中首次出血清除量越多,穿刺针数越少,术后并发颅内感染的概率越小;36例微创穿刺手术后并发颅内感染的高血压脑出血患者中,年龄>60岁、脑脊液漏、留置引流时间>3d、引流管污染的患者术后颅内感染率明显较高,差异有统计学意义(P<0.05);36例患者送检标本中共检出病原菌42株,其中革兰阳性菌22株占52.38%,以凝固酶阴性葡萄球菌为主,革兰阴性菌16株占38.10%,以肺炎克雷伯菌为主;真菌仅有4株占9.52%,以热带假丝酵母菌为主。结论微创穿刺治疗高血压脑出血术后颅内感染,与多种影响因素有关,临床治疗时,术中应严格无菌操作,术后应全面综合治疗,以降低感染率。

OBJECTIVE To investigate the high risk factors for postoperative intracranial infections in hypertensive cerebral hemorrhage patients receiving minimally invasive treatment and put forward the effective prevention strategies so as to improve the clinical effect.METHODS A total of 36 hypertensive cerebral hemorrhage patients complicated with postoperative intracranial infections who received the minimally invasive treatment from Jan 2013 to Jan 2015 were recruited as the study objects,then the retrospective survey was conducted for the clinical data of the patients,The volume of removal of initial hemorrhage and influence of number of puncture needles on the incidence of intracranial infections were observed,the high risk factors for the postoperative intracranial infections and species of pathogens were analyzed,and the statistical analysis was performed with the use of SPSS18.0software.RESULTS The more the volume of removal of initial hemorrhage,the less the puncture needles,the lower the possibility of the postoperative complicated intracranial infections.Among the 36 hypertensive cerebral hemorrhage patients complicated with postoperative intracranial infections,the incidence rate of the postoperative intracranial infections was relatively high in the patients aged more than 60 years old,the patients with cerebrospinal fluid leakage,the patients with indwelling drainage time more than 3days,or the patients with drainage tubes contaminated,and there was significant difference（P〈0.05）.Totally 42 strains of pathogens were isolated from the submitted specimens of the 36 patients,of which 52.38%（22strains）were gram-positive bacteria,38.10%（16strains）were gram-negative bacteria,and 9.52%（4strains）were fungi;the coagulase-negative Staphylococcus was the predominant species of the gram-positive bacteria,the Klebsiella pneumoniae was dominant among the gram-negative bacteria,and the Candida tropicalis was the major species of fungi.CONCLUSIONThere are a variety of influencing factors for the postoperative intracranial infections in the hypertensive cerebral hemorrhage patients receiving the minimally invasive treatment.It is necessary for the hospital to strictly follow the aseptic operations and conduct the comprehensive treatment so as to reduce the infection rate.