颅脑手术后发生颅内感染相关危险因素的meta分析

A meta analysis about related risk factors of intracranial infection aftercraniotomy

目的分析颅脑手术后发生颅内感染的相关危险因素,为减少颅脑手术后发生颅内感染提供依据。方法检索Web of Science、PubMed、Scopuss、Karger、EBSCO+Medline、Embase、中国知网、万方、维普数据库所收录的颅脑术后并发颅内感染的相关文献,检索时间为2009-2018年,采用Newcastle-Ottawa Scale(NOS)量表评价文献,采用STATA12.0分析数据。结果最终纳入符合条件的研究30项,共计36 773例患者。分析结果显示,颅脑手术后发生颅内感染的危险因素包括切口类型、二次手术、术后格拉斯哥昏迷评分(GCS评分)、术后脑脊液漏、手术时间、术中留置引流,而年龄、合并糖尿病、预防性使用抗菌药物、手术部位、急诊手术与术后发生颅内感染无关。围手术期使用激素与颅脑术后发生颅内感染存在争议。结论避免再次手术、脑脊液漏、不必要的引流,以及缩短手术时间将利于减少颅内感染发生,对于污染切口及术后GCS评分小于8分的患者更需警惕颅脑术后发生颅内感染。

Objective To analyze the risk factors associated with intracranial infection after craniocerebral surgery,and to provide evidence for reducing intracranial infection after craniocerebral surgery. Methods The literatures related to intracranial infections after craniocerebral surgery included in Web of Science,PubMed,Scopuss,Karger,EBSCO+Medline,Embase,China Knowledge Network,Wanfang,and Weipu Database were retrieved.The search time was from 2009 to 2018.The literature was evaluated using the Newcastle-Ottawa Scale (NOS) scale and the data was analyzed using STATA12.0. Results Thirty eligible studies were eventually included in a total of 36 773 patients.The analysis showed that risk factors for intracranial infection after craniocerebral surgery included incision type,secondary surgery,postoperative GCS score,postoperative cerebrospinal fluid leakage,operative time,and intraoperative indwelling drainage.Age,diabetes,preventive use of antibiotics,surgical sites,and emergency surgery were not associated with intracranial infection.Perioperative use of hormones and intracranial infections after craniocerebral surgery were controversial. Conclusion Avoiding reoperation,cerebrospinal fluid leakage,unnecessary drainage,and shortening the operation time will help reduce the incidence of intracranial infection.For patients with contaminated incision and postoperative GCS of less than 8 points,it is necessary to be alert to intracranial infection after craniocerebral operation.