第四脑室肿瘤切除术后患儿颅内感染的危险因素分析及护理干预

Risk factors and nursing of intracranial infection among children after fourth ventricle tumor resection

目的分析第四脑室肿瘤术后患儿颅内感染的危险因素,并总结有效护理干预措施。方法回顾性分析2013年6月—2017年6月在首都医科大学附属北京天坛医院神经外科收治的153例第四脑室肿瘤患儿。根据术后是否并发颅内感染分为感染组(n=45)和非感染组(n=108),从护理角度对比观察两组第四脑室肿瘤切除患儿术前、术中、术后相关因素间的差异,采用Logistic回归分析颅内感染的危险因素。结果单因素分析示,两组患儿下列变量差异有统计学意义:感染组术前住院天数>5 d(χ^2=5.418,P=0.020),手术时间≥4 h(χ^2=4.189,P=0.041),术后皮下积液(χ^2=4.452,P=0.049);年龄、肿瘤类别、肿瘤直径、肿瘤术后残留、肿瘤与第四脑室底粘连、手术季节、既往颅脑手术史、术前脑室腹腔分流、放置外引流管、术后低白蛋白血症、术后使用糖皮质激素等变量差异均无统计学意义(P>0.05)。Logistic回归分析示,术前住院时间>5 d(OR=4.340,P=0.010)、术后皮下积液(OR=9.169,P=0.011)是第四脑室肿瘤切除术后患儿颅内感染的危险因素。结论术前住院时间>5 d及术后皮下积液可增加第四脑室肿瘤切除术后患儿颅内感染的发生率,医护人员应提高对第四脑室肿瘤术后患儿感染危险因素的认识并采取针对性的护理预防措施。

Objective To analyze the risk factors of intracranial infection among children after fourth ventricle tumor resection and to summarize the effective nursing intervention. Methods Retrospective analysis was carried out in 153 children with fourth ventricle tumor in neurosurgery at Beijing Tiantan Hospital of Capital Medical University from June 2013 to June 2017. All of the children were divided into infection group (n=45) and non-infection group (n=108) according to whether complicated with intracranial infection after surgery. From nursing viewpoint, we compared the differences in related factors of children with fourth ventricle tumor resection between two groups before, during and after surgery. Logistic regression was used to analyze the risk factors of intracranial infection. Results Single factor analysis showed there were statistical differences in the hospital day before surgery > 5 days (χ^2=5.418, P=0.020), operative time ≥4 hours (χ^2=4.189, P=0.041) and subcutaneous hydrops (χ^2=4.452, P=0.049) among children between two groups. However, there were no statistical differences in ages, types of tumor, diameter of tumor, remains after tumor resection, adhesion between tumor and fourth ventricle, operative season, history of brain surgery, distributary of ventriculoperitoneal before surgery, setting external drainage, hypoalbuminemia and usage of glucocorticoid after surgery (P>0.05). Logistic regression analysis showed that the risk factors influencing intracranial infection of children after fourth ventricle tumor resection included the hospital day before surgery> 5 days (OR=4.340, P=0.010) and subcutaneous hydrops (OR=9.169, P=0.011). Conclusions Hospital day before surgery > 5 days and subcutaneous hydrops can increase the incidence of intracranial infection among children after fourth ventricle tumor resection. Medical staff should improve their cognition on risk factors of infection among children after fourth ventricle tumor resection and take targeted nursing intervention.