脑室腹腔分流术后感染的影响因素及手术操作改良

Related factors of postoperative infection and improvement of surgical operation after ventriculoperitoneal shunt

目的分析脑室腹腔分流术(VPS)术后感染的相关因素,为临床有效预防控制术后感染提供依据;并探讨对手术进行改良的方法,以降低术后感染率。方法选取290例次采用改良常规VPS治疗脑积水作为改良组,釆用常规治疗脑积水188例次作为对照组,比较两组患者术后感染率。应用SPSS 20.0统计软件分析改良组患者的年龄分布、脑积水类型及术前状况等不同因素条件下的术后感染率,并对感染因素进行分析。结果改良组202例患者临床应用改良式的VPS治疗共290次,感染率为6.55%(19/290);对照组138例患者,应用常规的VPS治疗共188次,感染率为13.83%(26/188),改良组患者的术后感染率显著低于对照组(χ~2=5.022、P=0.021)。改良组和对照组患者中早期感染分别为13例(68.42%)和20例(76.92%),但差异无统计学意义(χ~2=0.724、P=0.415)。改良组患者290次手术中,年龄<1岁与≥1岁患者感染率差异具有统计学意义(χ~2=10.131、P=0.001)。预防性使用抗菌药物(χ~2=4.297、P=0.039)、骨膜完整保留及缝合包埋穿刺孔(χ~2=8.924、P=0.005)和小的弧形头部皮肤切口(χ~2=7.209、P=0.015)与术后感染相关。结论预防性使用抗菌药物、骨膜完整保留及缝合包埋穿刺孔、小的弧形头部皮肤切口为术后感染的保护因素,有利于降低术后感染率。

Objective To analyze the related factors of postoperative infection after ventriculoperitoneal shunt （VPS） and to provide the basis for the effective prevention and control of postoperative infection; and to explore the methods to improve the operation for reducing the rate of postoperative infection. Methods Total of 290 cases were selected as the improved group who were given improvement of conventional VPS in the treatment of hydrocephalus, while 188 cases with the conventional treatment of hydrocephalus were selected as the control group, the rate of postoperative infection were compared between the two groups. The age distribution, hydrocephalus type, preoperative status of different factors between the incidence of postoperative infection, and the infection factors of patients in the improved group were analyzed by SPSS 20.0 statistical analysis software, while the related factors of postoperative infection were analyzed. Results Among the modified group, 202 patients were treated with modified VPS for 290 times, and the infection rate was 6.55% （19/290）. The control group of 138 patients, the use of conventional VPS 188 case-times, the infection rate was 13.83% （26/188）, the postoperative infection rate of the modified group was significantly lower than that of the control group （x^2 = 5.022, P = 0.021）. The early infection in the modified and control groups were 13 （68.42%） and 20 （76.92%）, respectively, but with no significant differences （x^2= 0.724, P = 0.415）. The early infection in the modified and control groups were 13 （68.42%） and 20 （76.92%）, respectively, with significant differences （x^2 = 10.131, P = 0.001）. Prophylactic use of antimicrobial agents （x^2 = 4.297, P = 0.039）, complete preservation of periosteum and suture, embedding of puncture holes （x^2 = 8.924, P = 0.005） and small arc head skin incision （x^2 = 7.209, P = 0.015） were associated with postoperative infection. Conclusions Prophylactic use of antibiotics, complete preservation of periosteum and suture embedding puncture holes, small arc head skin incision were all the protective factors of postoperative infection, which were helpful to reduce the rate of postoperative infection.