颅脑外伤术后医院感染危险因素分析

Risk factors of nosocomial infection after craniocerebral trauma

目的分析颅脑外伤术后医院感染危险因素。方法选择杭州市大江东医院于2016年6月至2019年6月收治的颅脑外伤患者314例,均行外科手术治疗,根据术后是否发生感染分为感染组(n=29)与未感染组(n=285)。采用多因素logistic回归分析影响颅脑外伤术后医院感染危险因素。结果颅脑外伤314例患者,发生术后医院感染29例(9.24%)。经单因素分析显示,两组性别、合并高血压和受伤类型差异均无统计学意义(均P>0.05);感染组年龄>60岁比例(15.91%)高于未感染组(4.40%),合并糖尿病比例(26.23%)高于未感染组(8.50%),术前格拉斯哥昏迷指数(GCS)评分<8分比例(15.75%)高于未感染组(4.81%),手术时间>10 d比例(14.09%)高于未感染组(4.85%),侵袭性操作比例(19.49%)高于未感染组(3.06%),脑脊液漏比例(19.15%)高于未感染组(5.00%),脑室外引流比例(25.00%)高于未感染组(4.20%),差异均有统计学意义(χ^2=12.099、11.706、10.789、5.954、7.984、23.720、15.728、29.726,均P<0.05)。将上述单因素分析差异有统计学意义的纳入多因素logistic回归分析显示,年龄>60岁、合并糖尿病、术前GCS评分<8分、手术时间>3 h、住院时间>10 d、侵袭性操作、脑脊液漏和脑室外引流为影响术后医院感染危险因素。结论颅脑外伤术后医院感染受多因素影响,其中年龄、糖尿病、术前GCS评分、手术时长、住院日程、侵袭性操作、脑脊液漏和脑室外引流为其危险因素。

Objective To analyze the risk factors of nosocomial infection after craniocerebral trauma.Methods From June 2016 to June 2019,314 patients with craniocerebral injury admitted to Dajiangdong Hospital were treated with surgical operation.According to whether infection occurred after operation,they were divided into infection group(n=29)and uninfected group(n=285).Multivariate logistic regression was used to analyze the risk factors of nosocomial infection after craniocerebral injury.Results Of 314 patients with craniocerebral injury,29 cases(9.24%)had postoperative nosocomial infection.Single factor analysis showed that there were no significant differences between the two groups in gender,hypertension and injury type(all P>0.05).The proportion of age>60 years old in the infected group(15.91%)was higher than that in the uninfected group(4.40%),the proportion of diabetes mellitus in the infected group(26.23%)was higher than that in the uninfected group(8.50%),the proportion of preoperative GCS score<8 points in the infected group(15.75%)was higher than that in the uninfected group(4.81%),and the proportion of operation time>10 d in the infected group(14.09%)was higher than that in the uninfected group(4.85%),invasive operation rate in the infected group(19.49%)was higher than in the uninfected group(3.06%),CSF leakage rate in the infected group(19.15%)was higher than in the uninfected group(5.00%),extraventricular drainage rate in the infected group(25.00%)was higher than than in the uninfected group(4.20%),the differences were statistically significant(χ^2=12.099,11.706,10.789,5.954,7.984,23.720,15.728,29.726,all P<0.05).The logistic regression analysis showed that age>60 years old,complicated with diabetes mellitus,preoperative GCS score<8 points,operation time>3 h,hospital stay>10 d,invasive operation,CSF leakage and ventricular drainage were the risk factors of postoperative hospital infection.Conclusion Nosocomial infection after craniocerebral trauma is affected by many factors,including age,diabetes mellitus,preoperative GCS score,operation time,hospitalization time,invasive operation,cerebrospinal fluid leakage and extraventricular drainage.