内镜下脑脊液鼻漏修补术后颅内感染的影响因素

Factors of postoperative intracranial infection after endoscopic repair of cerebrospinal fluid rhinorrhea

目的探究经鼻内镜下脑脊液鼻漏修补术后发生颅内感染的危险因素,以期能为后期治疗提供参考。方法选取2010年1月-2015年1月该院收治的80例经鼻内镜下脑脊液鼻漏修补术患者为研究对象,回顾性分析80例患者的临床资料,分析患者的年龄、性别、病因、漏口大小、漏口位置、既往有无颅内感染、预防性抗生素、术后应用抗菌药物>7 d、手术次数、手术是否使用人工材料、修复材料的选择、脑脊液鼻漏修补失败与经鼻内镜下脑脊液鼻漏修补术后发生颅内感染的相关性。结果 80例患者中4例(5.00%)患者术后发生颅内感染,对4例患者进行脑脊液细菌培养,共分离出8株病原菌,包括3例革兰阴性菌和5株革兰阳性菌,革兰阳性菌主要为金黄色葡萄球菌,占40.00%。单因素分析结果显示,脑脊液鼻漏修补失败、手术操作不当、修复材料的选择、既往有颅内感染病史和漏口大小直径>1 cm与经鼻内镜下脑脊液鼻漏修补术后发生颅内感染有一定的相关性(P<0.05)。多因素Logistic分析结果显示,脑脊液鼻漏修补失败、手术操作不当、既往有颅内感染病史、修复材料的选择和漏口大小直径>1 cm为经鼻内镜下脑脊液鼻漏修补术后发生颅内感染的独立危险因素(P<0.05)。结论颅底漏口大小直径>1 cm、有既往颅内感染史、脑脊液鼻漏修补失败和手术失败因素等多种因素均可能会增大经鼻内镜下脑脊液鼻漏修补术患者术后颅内感染的发生率。

Objectives To investigate risk factors for postoperative intracranial infection after nasal endoscopic repair of cerebrospinal fluid rhinorrhea, in order to provide a reference for later treatment. Methods Selected 80 cases treated by nasal endoscopic repair of cerebrospinal fluid rhinorrhea from January 2010 to 2015 as study object, retrospective analyzed the clinical data such as the patient＇s age, gender, etiology, leak size, the leak location, prior intraeranial infection, prophylactic antibiotics and postoperative application of antibacterial drug 〉 7 d, the number of operations, whether or not the operation using artificial materials, repair materials, repair of cerebrospinal fluid rhinorrhea failure and by nasal endoscopic repair of cerebrospinal fluid rhinon＇hea occurred between intracranial infection. Results 4 of them （5.00 %） occurred intracranial infection. CSF bacterial culture show 8 strains of pathogenic bacteria were isolated, including 3 cases of leather of gram negative bacteria and 5 strains of leather of gram positive bacteria and gram positive bacteria were mainly Staphylococcus aureus and accounted for 40.00 %. Univariate anal- ysis showed that repair of cerebrospinal fluid rhinorrhea failure, improper surgical procedures, previous intraeranial infection history, the choice of restorative materials and the size of the leak diameter 〉 1 cm and after endoscopic repair of eerebrospinal fluid rhinorrhea postoperative intraeranial infection have some relevance （P 〈 0.05）. Logistic multivariate analysis showed that repair of cerebrospinal fluid rhinorrhea failure, improper surgical procedures, previous intraeranial infection history, the choice of restorative materials and the size of the leak diameter 〉 1 em of intranasal endoscopic repair of cerebrospinal fluid rhinorrhea independent risk factor for postoperative intracranial infection （P 〈 0.05）. Conclusions Skull size of the leak diameter 〉 1 cm, previous history of intracranial infection, cerebrospinal fluid rhinorrhea repair a variety of factors fail, surgery failure factors are likely to increase patient after endoscopic repair of cerebrospinal fluid rhinorrhea intracranial infection the incidence.