改良开颅手术备皮策略在神经外科中的应用效果

Application of modified preoperative skin preparation for craniotomy in neurosurgery

目的：探讨在神经外科广泛推行改良的开颅手术备皮策略的可行性。方法应用医学循证学方法，制定北京协和医院神经外科术前皮肤准备改良策略。2011年12月—2012年1月将80例患者随机分为传统备皮组和改良策略组，每组各40例，传统备皮组沿用传统的一次性备皮刀术前剃头，干预组采用改良的开颅手术术前皮肤方法。对比两种备皮方式下患者手术部位感染率及医护患三方满意度。结果改良组医生、护士和患者的满意度优于传统组，差异有统计学意义（P ＜0．01）。2009年1月—2014年7月共1294例患者接受手术，其中改良组发生感染24例，未发生感染684例，传统组发生感染70例，未发生感染516例，两组比较差异有统计学意义（χ2＝34．83，P ＜0．01）。结论应用术前皮肤准备改良策略，可以提升临床医疗护理质量，提高工作效率，对于预防神经外科开颅手术后颅内感染具有积极意义，适合在神经外科广泛推广。

Objective To discuss the feasibility about the widely implementation improved skin preparation for craniotomy in neurosurgery.Methods Improved strategies about skin preparation in PUMCH′s neurosurgery were established by evidence-based medicine.From December 2011 to January 201 2,80 cases were randomly assigned to traditional and modified group,40 cases in each one.Traditional group applied the disposable blade to shave head preoperation,while intervention group used modified strategic method.The incidence of surgical sites infection and satisfaction of doctor-nurse-patient were compared of between two methods. Results Satisfaction of doctor-nurse-patient of intervention group was better than the traditional group （P 〈0.01 ）.A total of 1 294 cases participated the research from January 2009 to July 201 4.There were 24 cases infected and 684 uninfected in intervention group,comparing with 70 infected and 51 6 uninfected in the traditional group （χ2 =34.83,P 〈0.01 ）.Conclusions The improved preoperative skin preparation can improve clinical quality of care,increase productivity,and prevent intracranial infection after craniotomy positively,which can be widely applied in neurosurgery.