有创颅内压监测并发颅内感染及颅内出血的多因素分析

Multivariate analysis of intracranial infection and intracranial hemorrhage in invasive intracranial pressure monitoring

目的探究有创颅内压监测并发颅内感染和颅内出血的相关因素，为降低有创颅内压监测并发症的发生率提供参考。方法采用回顾性病例系列研究分析2009年10月-2016年6月349例行有创颅内压监测颅脑损伤患者的临床资料，对是否并发颅内感染和颅内出血分别进行对比分析。与并发颅内感染相关的因素包括性别、年龄、是否为颅内破裂动脉瘤、探头类型、探头置入方式、探头留置时间、是否行开颅手术、开颅手术时间、是否合并颅底骨折等；与并发颅内出血相关的因素包括性别、年龄、是否有高血压、探头置入前国际标准化比值（INR）、血小板计数、纤维蛋白原、探头类型、探头置入方式、探头置入部位是否有脑挫裂伤或出血灶等。行单因素及多因素Logistic回归分析确定并发颅内感染和颅内出血的独立危险因素。结果单因素分析结果表明，是否为颅内破裂动脉瘤（P〈0．05）、探头置入方式（P〈0．05）、探头留置时间（P〈0．05）、是否合并有颅底骨折（P〈0．05）为并发颅内感染相关因素。探头置入前INR（P〈0．05）、血小板计数（P〈0．05）、探头置入前同侧大脑半球是否有脑挫裂伤或出血灶（P〈0．05）、探头类型（P〈0．05）、探头置入方式（P〈0．05）为并发颅内出血的相关因素。多因素Logistic回归分析表明，颅内破裂动脉瘤（P〈0．05）、探头置入方式（P〈0．05）为并发颅内感染的独立危险因素；探头类型（P〈0．05）和探头置入方式（P〈0．05）为并发颅内出血的独立危险因素。结论颅内破裂动脉瘤和探头置入方式（开颅或钻颅）是有创颅内压监测并发颅内感染的独立危险因素。探头类型（脑室型）和探头置入方式（锥颅）是有创颅内压监测并发颅内出血的独立危险因素。临床上应严格把握有创颅内压监测指征，防范相关危险因素，降低有创颅内压监测的并发症。

Objective To investigate the related factors of intracranial infection and intracranial hemorrhage from invasive intracranial pressure monitoring so as to provide a reference for reducing the incidence rate of complications from invasive intracranial pressure monitoring. Methods The clinical data of 349 patients dealt with invasive intracranial pressure monitoring and admitted from October 2009 to June 2016 were retrospectively analyzed by case series study. The possible factors leading to intracranial infection included gender, age, disease classification, type of intracranial pressure probe, implantation method of the intracranial pressure probe, intracranial pressure probe retention time, implementation of craniotomy or not, surgery time, and combination with skull base fracture or not. The possible factors related to complicated intracranial hemorrhage included gender, age, hypertension, international standardized ratio （INR） before intracranial pressure probe implantation, platelet count, serum fibrinogen level, type of intracranial pressure probe, implantation method of the intracranial pressure probe, and the combination with brain contusion or bleeding around intracranial pressure probe implantation site or not. The related factors and independent risk factors of intracranial infection and intracranial hemorrhage were evaluated by univariate analysis and multivariate Logistic regression analysis. Results The univariate analysis showed disease classification （ ruptured intracranial aneurysms vs other diseases （ P 〈 0.05 ）, intracranial pressure probe implantation method （ P 〈 0.05 ）, retention time of intracranial pressure probe （P 〈 0.05 ）, and combination of basal skull fracture （ P 〈 0.05 ） were the related factors of intracranial infection. Multivariate Logistic regression analysis showed that the disease classification （ P 〈 0.05 ） and implantation method of intracranial pressure probe （ P 〈 0.05 ） were independent risk factors for intracranial infection. In addition, probe type （ P 〈 0.05 ） and implantation method of intracranial pressure probe （P 〈0.05） were independent risk factors for intracranial hemorrhage. Conclusions Ruptured intracranial aneurysms and implantation method for intracranial pressure probe （craniotomy or skull drilling） are independent risk factors for intracranial infection from invasive intracranial pressure monitoring. Type of probe （ventricttlar intracranial pressure probe） and implantation method for intracranial pressure probe （skull cone ） are independent risk factors for intracranial hemorrhage from invasive intracranial pressure monitoring. In clinical practice, the indications of invasive intracranial pressure monitoring should be strictly supervised and the relevant risk factors should be prevented to reduce the complications of invasive intracranial pressure monitoring.