神经内镜下经鼻蝶窦垂体瘤切除术手术部位感染的影响因素

Influencing factors for surgical site infection following neuroendoscopic transsphenoidal pituitary adenoma resection

目的分析神经内镜下经鼻蝶窦垂体瘤切除术手术部位感染(SSI)的危险因素,为预防与控制SSI提供参考依据。方法回顾性分析某院2015年4月—2017年4月神经内镜下经鼻蝶窦垂体瘤切除术患者的一般资料及SSI发生情况,应用SPSS 21.0统计软件进行数据分析。结果共纳入研究对象252例,发生SSI 15例,发病率为5.95%。单因素分析结果显示术前合并糖尿病、手术时间长、术中出血量大、输血、术后脑脊液漏是神经内镜下经鼻蝶窦垂体瘤切除术患者SSI的影响因素(均P<0.05);多因素logistic回归分析显示,发生脑脊液漏(OR=21.758,95%CI:4.132-114.567)、术前合并糖尿病(OR=10.025,95%CI:2.267-44.335)和手术时间≥3h(OR=11.622,95%CI:2.783-48.533)是神经内镜下经鼻蝶窦垂体瘤切除术患者SSI的独立危险因素。结论影响神经内镜下经鼻蝶窦垂体瘤切除术SSI的因素众多,术后脑脊液漏、术前合并糖尿病以及手术时间≥3h是发生SSI的独立危险因素,应针对危险因素采取有效的防控措施。

Objective To analyze the risk factors for surgical site infection（SSI）following neuroendoscopic transsphenoidal pituitary adenoma resection（NTPAR）,provide theoretical basis for prevention and control of SSI.Methods General data and occurrence of SSI of patients who underwent NTPAR in a hospital from April 2015 to April2017 were analyzed retrospectively,data were analyzed by SPSS 21.0 software.Results A total of 252 subjects were included in the study,15 SSI cases occurred,incidence was 5.95%.Univariate analysis results showed that preoperative diabetes mellitus,long length of operation time,large amount of intraoperative bleeding,blood transfusion,postoperative cerebrospinal fluid leakage were influencing factors for SSI in patients undergoing NTPAR（all P〈0.05）;multivariate logistic analysis results showed that cerebrospinal fluid leakage（OR=21.758,95%CI：4.132-114.567）,preoperative diabetes mellitus（OR=10.025,95%CI：2.267-44.335）,length of operation time≥3 hours（OR=11.622,95%CI：2.783-48.533）were independent risk factors for SSI in patients undergoing NTPAR.Conclusion There are many factors that influence SSI following NTPAR,postoperative cerebrospinal fluid leakage,preoperative diabetes mellitus,and length of operation time≥3 hours are independent risk factors for SSI,effective prevention and control measures should be taken against the risk factors.