重型颅脑创伤和重症高血压脑出血患者有创颅内压监测术后早期颅内感染及其危险因素

Incidence of and Risk Factors for Early Intracranial Infection after Invasive Intracranial Pressure Monitoring for Severe Traumatic Brain Injury or Hypertensive Intracranial Hemorrhage

目的重型颅脑创伤和重症高血压脑出血患者具备有创颅内压监测指征,探讨有创颅内压监测术后早期颅内感染发生率及危险因素。方法对226例重型颅脑创伤和重症高血压脑出血患者进行回顾性分析,按术中有无有创颅内压监测分为监测组和传统手术组(对照组)。观察术后1周内早期颅内感染的发生情况,并对感染危险因素进行分析。结果监测组45例患者中,颅脑创伤30例,高血压脑出血15例;对照组181例患者中,颅脑创伤96例,高血压脑出血85例。术后1周内,监测组颅内感染7例(15.56%),其中颅脑创伤4例(8.89%),高血压脑出血3例(6.67%);对照组颅内感染30例(16.57%),其中颅脑创伤15例(8.29%),高血压脑出血15例(8.29%)。2组比较,术后早期颅内感染发生率无统计学差异(P>0.05)。颅底骨折、术后营养指标、术后间断开放脑室型外引流管是监测组发生术后早期颅内感染的危险因素(P<0.05),而术后间断开放脑室型外引流管是独立危险因素(P<0.05)。结论术后1周内,在重型颅脑创伤和高血压脑出血患者中有创颅内压监测与传统手术比较不会增加颅内感染的风险,术后尽可能规避间断开放脑室型外引流管,可以在一定程度上防止有创颅内压监测术后早期颅内感染的发生。

Objective To investigate the incidence of and risk factors for early intracranial infection after invasive intracranial pressure monitoring in patients with severe traumatic brain injury or hypertensive intracranial hemorrhage.Methods A total of 226 patients with severe traumatic brain injury or hypertensive intracranial hemorrhage admitted to our department were retrospectively analyzed and divided into the monitoring group and the traditional operation group(control group),according to the presence or absence of invasive intracranial pressure monitoring.The incidence of and risk factors for early intracranial infection within 1 week after surgery were compared between the groups.Results Among 45 patients in the monitoring group,30 had traumatic brain injury and 15 had hypertensive intracranial hemorrhage.Among 181 patients in the control group,96 had traumatic brain injury and 85 had hypertensive intracranial hemorrhage.Within 1 week after surgery,intracranial infection occurred in 7 patients(15.56%)in the monitoring group and in 30 patients(16.57%)in the control group.There was no significant difference in the incidence of early intracranial infection between the two groups.Fracture of the skull base,postoperative nutritional index,and intermittent open ventricular drainage were risk factors for early intracranial infection in the monitoring group,and intermittent open ventricular drainage was an independent risk factor.Conclusion Invasive intracranial pressure monitoring does not increase the risk for intracranial infection within 1 week after severe traumatic brain injury or hypertensive intracranial hemorrhage compared with the traditional operation.Early intracranial infection can be prevented by avoiding intermittent open ventricular drainage.