颅内肿瘤手术患者医院感染危险因素分析

Analysis of risk factors for nosocomial infection in patients after intracranial tumor surgery

目的探讨颅内肿瘤开颅手术患者医院感染的危险因素及其防治措施。方法回顾性分析2014年1月至2016年6月在我院神经外科行开颅手术的288例颅内肿瘤患者的临床资料,对医院感染发生率、感染部位、病原菌分布和医院感染危险因素进行分析。结果 288例患者中发生医院感染41例,感染率为14.24%;感染部位分布:肺部27例、颅内7例、泌尿系3例、血液2例、切口2例。单因素分析显示手术部位、手术时间、引流管留置时间、手术中输血是颅内肿瘤患者术后发生医院感染的危险因素(P<0.05);多因素logistic回归分析显示手术部位、术后留置引流管时间、手术中输血是颅内肿瘤开颅术后患者发生医院感染的独立危险因素。结论颅内肿瘤开颅手术患者医院感染率为14.24%,主要感染部位是肺部,实施幕下肿瘤手术、手术中输血和术后留置引流管时间大于2 d的患者颅内肿瘤术后发生医院感染的危险较高,应采取合理预防措施,有效控制和避免医院感染发生。

Objective To explore risk factors for hospital infections following craniotomy to treat intracranial tumors and to assess potential prevention measures. Methods Medical records were retrospectively reviewed for 288 patients treated between January 2014 and June 2016 at the Affilated Tumor Hospital of Guangxi Medical University. Potential risk factors for hospital infection were identified.Results Nosocomial infection occurred in 41 of 288 patients （14.24%）, comprising 27 pulmonary infections, 7 intracranial infections, 3 urinary tract infections, 2 blood infections, and 2 incision infections. Univariate anlysis identified the following risk factors for nosocomial infection： surgical site, operation time, drainage tube indwelling time, and surgical transfusion. Multivariate logistic regression identified the following independent risk factors： surgical site,drainage tube indwelling time longer than two days,and blood transfusion. Conclusion The rate of nosocomial infection among patients undergoing intracranial tumor craniotomy at our hospital was relatively high（14.24%）, and lung was the main infection site. Risk of nosocomial infection was particularly high among patients who underwent infratentorial removal of intracranial tumors or intra-operative blood transfusion,or who had a postoperative drainage time longer than 2 days. These results suggest that should take reasonable measures to reduce incidence of nosocomial infection.