脑出血患者血肿清除术后合并手术部位感染危险因素分析

Risk factors of patients with cerebral hemorrhage after hematoma evacuation combined with surgical site infection

目的分析脑出血患者血肿清除术后合并手术部位感染的病原菌分布与相关危险因素。方法回顾性分析2017年5月至2019年5月在我院接受血肿清除术治疗的109例脑出血患者的临床资料,依据术后是否并发感染分为感染组(n=45)与非感染组(n=64),分析感染组患者感染部位及病原菌分布情况,比较感染组与非感染组氧化应激指标[超氧化物歧化酶(SOD)、高级氧化蛋白产物(AOPP)、丙二醛(MDA)]水平,同时采用多因素Logistic回归分析脑出血患者血肿清除术后感染的危险因素。结果 45例血肿清除术后感染患者感染部位以呼吸道为主(31.11%),共分离病原菌83株,其中革兰阴性菌57株(68.67%),革兰阳性菌17株(20.48%),真菌9株(10.84%)。感染组患者血清MDA、AOPP水平显著高于非感染组,而SOD水平显著低于非感染组(均P<0.05)。Logistic分析显示MDA、SOD、AOPP水平是脑出血患者血肿清除术后感染的独立危险因素(均P<0.05)。结论脑出血患者血肿清除术后以呼吸道感染为主,感染病原菌以革兰阴性菌为主,且病原菌感染与氧化应激反应密切相关。临床治疗时应严格规范使用抗菌药物,同时针对其危险因素进行预防,以防止血肿清除术后感染,促进患者术后恢复。

Objective To investigate the pathogen distribution and risk factors in patients with cerebral hemorrhage after hematoma evacuation combined with surgical site infection. Methods The clinical data of 109 patients with cerebral hemorrhage underwent hematoma evacuation in our hospital from May 2017 to May 2019 were reviewed. The patients were divided into infection group(n=45) or non-infection group(n=64) according to the presence or absence of the postoperative infection. The infection site and pathogen distribution in the infection group were analyzed. The oxidative stress indexes [superoxide dismutase(SOD), advanced oxidation protein products(AOPP), malondialdehyde(MDA)] were compared between the two groups.The risk factors of postoperative infection in patients with cerebral hemorrhage who received hematoma evacuation were determined by multivariate Logistic analysis. Results Respiratory tract was the main infection site in 45 patients(31.11%) after hematoma removal. A total of 83 pathogenic bacteria were isolated, including 57 strains of Gram-negative bacteria(68.67%), 17 strains of Gram-positive bacteria(20.48%), and 9 strains of fungi(10.84%). Serum levels of MDA and AOPP were significantly higher while serum SOD level was significantly lower in the infection group than in the non-infection group, respectively(all P<0.05). The levels of MDA, SOD and AOPP were independent risk factors for infection after removal of hematoma in patients with cerebral hemorrhage(all P<0.05). Conclusion Respiratory tract is the main infection site among patients with cerebral hemorrhage after hematoma evacuation, and pathogenic bacteria are mainly Gram-negative bacteria;moreover, pathogenic bacteria infection is closely related to oxidative stress response. Therefore, clinical use of antibiotics should be rational to prevent infections, and promote the recovery of patients after operation.