1033例神经外科择期手术感染分析

Infection in 1033 neurosurgery department patients undergoing selective surgery

目的主要研究医院神经外科7年来择期手术相关感染率以及高危因素分析。方法对2008-2014年度1 033例神经外科择期手术病例进行回顾性研究,对手术相关感染率、致病菌以及感染相关因素进行分析。结果 1 033例病人共发生术后感染33例占3.19%,40例次的术后切口相关感染;20例次为切口感染占1.94%,20例次为颅内/椎管内感染占1.94%,其中15例为颅内感染,5例为椎管内感染;自2011年开始术中预防性使用抗菌药物以来,2011-2014年度手术相关感染率较2008-2010年度感染率下降56.4%,差异有统计学意义(P<0.05);术后感染发生率最高的病种是颅骨修补占6.85%,其次为脊髓脊柱疾病占6.80%和脑室腹腔分流手术占5.52%;最常见的感染致病菌是葡萄球菌占27.5%;异物植入、手术时间大于4小时以及脑脊液漏分别是感染的高危因素(P<0.05)。结论术前预防性使用抗菌药物能够降低神经外科择期手术感染率;避免异物植入、缩短手术时间以及控制脑脊液漏发生率能够有效降低术后感染率。

OBJECTIVE To investigate the incidence of selective surgery‐related infection in neurosurgery depart‐ment patients in the past 7 years and analyze the high‐risk factors .METHODS A total of 1033 neurosurgery depart‐ment patients who received the selective surgery from 2008 to 2014 were retrospectively studied .The incidence of the surgery‐related infection ,distribution of pathogenic bacteria ,and related factors for infection were observed . RESULTS Of the 1033 patients ,33 （3 .19% ） had postoperative infection ,40 case‐times of patients had postopera‐tive incision‐related infection ,20 （1 .94% ） case‐times of patients had incision infection ,and 20 （1 .94% ） case‐times of patients had intracranial infection （15 cases ） and intraspinal infection （5 cases） .The intraoperative prophylactic use of antibiotics was carried out since 2011 ,as compared with the infection rate in 2008‐2010 ,the incidence of the surgery‐related infection was decreased by 56 .4% in 2011‐2014 ,and there was significant differ‐ence （P〈0 .05） .The incidence of postoperative infection was the highest in the patients undergoing cranioplasty （6 .85% ） ,followed by the patients with spinal cord and spinal disease （6 .80% ） and the patients undergoing ven‐triculoperitoneal shunt surgery （5 .52% ） .Staphylococcus was the most common species of pathogen causing the infection ,accounting for 27 .5% .Foreign body implantation ,operation duration more than 4 hours ,and cerebro‐spinal fluid leakage were the high‐risk factors for the infections .CONCLUSION The preoperative prophylactic use of antibiotics can reduce the infection rate in the neurosurgery department patients undergoing the selective surger‐y .It is an effective way to avoid the foreign body implantation ,shorten the operation duration ,and control the in‐cidence of cerebrospinal fluid leakage so as to reduce the incidence of postoperative infections .