老年重症颅脑外伤术后出现颅内感染的危险因素分析及干预措施

Analysis of risk factors and intervention measures of postoperative intracranial infection after senile severe craniocerebral trauma

目的分析老年重症颅脑外伤术后出现颅内感染的危险因素并提出相应的干预措施。方法收集我院于2014年1月至2015年1月收治的老年重症颅脑外伤术后出现颅内感染患者65例,并选取同时期重症颅脑外伤术后未出现颅内感染的71例患者的临床资料,进行单因素及多因素分析。结果单因素分析发现患者的性别、年龄、开放性颅脑损伤、血糖水平和出现颅内感染无明显相关(P>0.05),而术前GCS评分、手术次数、手术时间、术后白蛋白、术后切口脑脊液漏和出现颅内感染明显相关(P<0.05);多因素Logistic回归分析结果显示:手术次数、手术时间、术后是否出现低蛋白血症以及是否出现切口脑脊液漏与出现颅内感染明显相关(P<0.05)。共培养出病原菌37株,占感染患者总数的56.92%,其中主要为革兰阴性菌。结论老年重症颅脑外伤患者术后出现颅内感染的因素多样,医护人员需提高自身技术,给予患者更多的关心,降低颅内感染的几率。

Objective To analyze the risk factors of postoperative intracranial infection after senile severe craniocerebral trauma surgery and put forward intervention measures. Methods From January 2014 to January 2015, the clinical data of 65 cases of senile patients with postoperative intracranial infection after severe craniocerebral trauma surgery and 71 patients with no intracranial infection after severe craniocerebral trauma in our hospital were selected and analyzed by the univariate and multivariate analysis. Results Univariate analysis showed that there were no significant correlation between gender, age, open craniocerebral injury, blood glucose level and intracranial infection （P〉0.05）; whlie preoperative GCS score, the number of operation, operation time, postoperative albumin content, postoperative cerebrospinal fluid leakage were significantly correlated with intracranial infection （P〈0.05）. The multivariate Logistic regression analysis showed that the number of operation, operation time, postoperative hypoproteinemia and the occurrence of cerebrospinal fluid leakage were significantly correlated with intracranial infection （P 〈0.05）. A total of 37 bacterial pathogens were cultured, accounting for 56.92% of the total number of infected patients, and most of them were gram-negative bacteria. Conclusion There are many factors of postoperative intracranial infection after senile severe craniocerebral trauma surgery. The medical staff need to improve their own technology, give patients more care, reduce the risk of intracranial infection.