神经外科清洁切口开颅术后手术部位感染发病率及危险因素的前瞻性研究

Prospective study on the incidence and risk factors of surgical site infection after clean incision craniotomy of neurosurgery

目的分析神经外科清洁切口开颅术后手术部位感染(SSI)的发病率及危险因素,为防控SSI提供依据。方法对2017年7月—2018年12月某三级甲等综合医院神经外科清洁切口开颅手术患者进行前瞻性SSI目标性监测,监测术后SSI发生情况,采用单因素及多因素logistic回归分析清洁切口开颅手术SSI的影响因素。结果神经外科1154例清洁切口开颅手术患者,发生SSI 105例,发病率为9.10%,其中,表浅手术切口感染11例,器官腔隙感染94例,无深部手术切口感染。多因素logistic回归分析结果显示,术后再次手术、放置引流时间≥4 d、手术时间≥4 h、急诊手术是该院清洁切口开颅手术SSI发生的独立危险因素。术后放置硬膜外/硬膜下引流管(不超过72 h)是清洁切口开颅手术SSI的保护性因素。神经外科清洁切口开颅手术发生SSI的患者中,87.62%(92/105)发生于术后2周内。结论为减少神经外科清洁切口开颅手术SSI的发生,应避免术后再次手术、缩短手术时间、加强急诊手术的管理,必要时需术后放置硬膜外/硬膜下引流管,但应尽早拔除引流管。

Objective To analyze the incidence and risk factors of surgical site infection(SSI)after clean incision craniotomy of neurosurgery,and provide basis for prevention and control of SSI.Methods From July 2017 to December 2018,patients with clean incision craniotomy in department of neurosurgery of a tertiary general hospital were prospectively monitored for SSI,occurrence of SSI was monitored,univariate analysis and multivariate logistic regression analysis were used to analyze the influencing factors for SSI in clean incision craniotomy.Results Among 1154 patients who underwent clean incision craniotomy,105(9.10%)had SSI,11 were superficial incision infection and 94 were organ space infection,there was no deep incision infection.Multivariate logistic regression analysis showed that reoperation,duration of postoperative drainage≥4 days,duration of operation≥4 hours and emergency operation were independent risk factors for SSI in clean incision craniotomy.Postoperative epidural/subdural drai-nage(no more than 72 hours)was a protective factor for SSI in clean incision craniotomy.87.62%(92/105)of patients developed SSI within 2 weeks after surgery.Conclusion In order to reduce the occurrence of SSI of clean incision craniotomy of neurosurgery,it is necessary to avoid reoperation,shorten operation time,strengthen mana-gement of emergency operation and place epidural/subdural drainage if necessary,but drainage tube should be removed as early as possible.