454例开颅清洁切口手术部位感染相关因素Logistic回归分析

Logistic regression analysis of infection related factors at surgical site in 454 cases of clean incision craniotomy

目的分析神经外科开颅清洁切口手术部位感染(SSI)的影响因素并提出感染控制措施。方法回顾性分析2016年1-12月454例神经外科开颅清洁切口手术的病历资料并进行统计学分析。结果 56例(12.33%)发生SSI,其中手术切口感染10例,器官腔隙感染47例,有1例同时发生了切口感染和器官腔隙感染。单因素分析显示:术中出血量大于或等于400mL、手术持续时间大于或等于4h、术前住院时间大于或等于7d、再次手术、留置脑室引流管、急诊手术、幕下肿瘤经后颅窝入路、术前合并糖尿病等因素与SSI的发生密切相关(P<0.05);多因素分析显示:术中出血量大于或等于400mL、再次手术、急诊手术、留置脑室引流管、手术持续时间大于或等于4h、术前住院时间大于或等于7d是神经外科开颅清洁切口手术SSI发生的独立危险因素(P<0.05)。结论应加强手术团队配合及急诊手术的管理、缩短手术时间及术前住院时间、减少术中出血量、避免再次手术、尽早拔除脑室引流管等,减少SSI的发生。

Objective To analyze the influencing factors of surgical site infection（SSI）in neurosurgical clean incision craniotomy with neurosurgery and to propose infection control measures.Methods The medical records data in 454 cases of neurosurgical craniotomy with clean incision from January to December 2016 were retrospectively performed and performed the statistical analysis.Results Among 454 cases,SSI occurred in 56 cases with the infection rate of 12.33%,in which 10 cases were the incision infection,47 cases were the organ cavity infection,and 1 case simultaneously had incision infection and organ lacunar infection.The univariate analysis results showed that the factors such as intraoperative blood≥400 mL,operation time≥4 h,preoperative hospital stay≥7 d,re-operation,indwelling the ventricle drainage tube,emergency surgery,infratentorial tumors through the posterior fossa approach,preoperative complicating diabetes had the close correlation with SSI occurrence,the differences were statistically significant（P〈0.05）.The multivariate analysis results indicated that intraoperative blood loss ≥ 400 mL,re-operation,emergency operation,indwelling ventricular drainage tube,operation time≥ 4 and preoperative hospitalization time≥ 7 dwere the independent risk factors for SSI occurrence in surgical incision of neurosurgical craniotomy（P〈0.05）.Conclusion There are many factors affecting SSI in clean incision craniotomy.It is necessary to strengthen the cooperation of the operation team and the management of emergency surgery,shorten the operation time and preoperative hospital stay,reduce the intraoperative bleeding,avoid the reoperation,removing the ventricle drainage tube as early as possible,and reduce the occurrence of SSI.