开颅患者术后颅内感染的病原学特点及影响因素分析

Etiological characteristics and influencing factors for intracranial infections in patients after craniotomy

目的探究开颅术后患者发生颅内感染的影响因素及检出病原菌的分布特点。方法选择2012年4月-2016年1月在医院神经外科住院治疗的1 126例颅内手术患者,回顾性分析患者的临床资料,采用单因素及多因素Logistic分析发生术后感染的影响因素,对感染患者脑脊液分离出的病原菌进行分析。结果 1 126例颅内手术患者中共有78例患者术后发生颅内感染,感染率为6.93%;患者的年龄、性别、体质量指数、手术类型、手术次数及合并相关基础疾病与患者术后发生颅内感染无关(P>0.05),而患者有无头皮下引流、有无脑脊液漏、ASA评分、手术时间及术后白蛋白是否低于35g/L是导致开颅术后患者颅内感染的相关因素;78例颅内感染患者的脑脊液标本中共分离出病原菌78株,其中主要以革兰阳性菌为主,共47株占60.26%,其次为革兰阴性菌,共24株占30.77%,真菌7株占8.97%。结论留置头皮下引流、脑脊液漏及手术时间是导致颅内手术患者术后发生颅内感染的相关影响因素,针对影响因素对患者进行预防,对降低术后感染率及提高患者预后有着重要意义。

OBJECTIVE To explore the influencing factors for intracranial infections in patients after craniotomy and investigate the distribution of pathogens.METHODS A total of 1 126 patients who received the craniotomy in neurosurgery department of the hospital from Apr 2012 to Jan 2016 were enrolled in the study,the clinical data of the patients were retrospectively analyzed,the univariate analysis and multivariate logistic analysis were performed for the influencing factors for the postoperative infections,and the pathogens that were isolated from cerebrospinal fluid specimens of the patients with the infections were observed.RESULTS Of the 1 126 patients who received the craniotomy,totally 78 patients had postoperative intracranial infections,with the infection rate 6.93%.The incidence of the postoperative intracranial infection was not associated with the age,gender,body mass index,types of surgery,number of times of surgery or complication with underlying diseases（P〉0.05）.The related factors for the postoperative intracranial infections in the patients undergoing the craniotomy included the subcutaneous drainage,leakage of cerebrospinal fluid,ASA,operation duration and postoperative albumin level less than 35 g/L.A total of 78 strains of pathogens were isolated from the cerebrospinal fluid specimens of the 78 patients with the intracranial infections,of which 47（60.26%）were gram-positive bacteria,24（30.77%）were gram-negative bacteria,and 7（8.97%）were fungi.CONCLUSIONSubcutaneous drainage indwelling,leakage of cerebrospinal fluid and operation duration are the related influencing factors for the postoperative intracranial infections in the patients undergoing the craniotomy.It is of great significance to take targeted prevention measures aiming at the influencing factors so as to reduce the incidence of the postoperative infections.