开颅术后颅内感染的相关因素探讨

Discussion on Related Factors of Intracranial Infection after Craniotomy

目的研究开颅手术后患者发生颅内感染的危险因素,从而制定出针对性应对策略。方法该次研究中所选取的病例均来自于该院在2015年1月—2020年1月期间收治的通过开颅手术治疗的患者,从中随机抽取出300例作为研究对象,对其资料进行回顾性分析,经统计,其中并发颅内感染的患者一共有15例,首先通过单因素方法,对引发颅内感染的影响因素进行研究分析,然后通过多因素分析确认与颅内感染相关的危险因素。结果发生颅内感染的患者与未发生颅内感染的患者术后脑脊液泄露(20.0%)、后颅窝手术治疗(53.3%)、手术时间超过4 h(60.0%)、脑室外引流(66.7%)、向颅内置入植入性材料(60.0%)、存在糖尿病(46.7%)、中枢神经系统合并感染疾病(20.0%)比较,差异有统计学意义(χ^(2)=8.711、12.632、10.730、5.080、5.053、6.328、6.597,P<0.05);发生颅内感染的患者与未发生颅内感染的患者乳突气房、出现开放性颅脑损伤、利用显微镜、硬脑膜敞开、引流治疗、术前使用糖皮质激素比较,差异无统计学意义(P>0.05)。多因素分析结果显示,颅内感染的影响因素为:术后脑脊液泄露、后颅窝手术治疗、手术时间超过4 h、脑室外引流、向颅内置入植入性材料、存在糖尿病、中枢神经系统合并感染疾病。结论临床治疗中,应该尽量减短手术时间、避免脑脊液发生外漏、将脑室外引流的时间尽量缩短、尽量不要使用人工植入性材料辅助治疗、有效控制血糖、对全身感染等情况进行有效预防,满足以上,可以大大降低颅内感染的发生率。

Objective To study the risk factors of intracranial infection in patients after craniotomy,so as to develop a targeted response strategy.Methods The cases selected in this study were all patients who were treated by craniotomy in the hospital from January 2015 to January 2020.300 cases were randomly selected as the research objects,and their data were collected and retrospectively analyzed,according to statistics,a total of 15 patients with intracranial infections.Firstly,single-factor methods were used to study and analyze the influecing factors for intracranial infections,and then multi-factor analysis was used to confirm the correlation with intracranial infections.Results Postoperative cerebrospinal fluid leakage in patients with intracranial infection and patients without intracranial infection(20.0%),surgical treatment of posterior fossa(53.3%),operation time more than 4 hours(60.0%),drainage from the ventricle(66.7%),implantable material into the skull(60.0%),diabetes(46.7%),central nervous system(20.0%)compared with co-infected diseases,the difference was statistically significant(χ^(2)=8.711,12.632,10.730,5.080,5.053,6.328,6.597,P<0.05).There was no statistically significant difference between patients with intracranial infection and patients without intracranial infection with mastoid air cells,open head injury,use of a microscope,dural opening,drainage therapy,and preoperative use of glucocorticoids(P>0.05).The results of multivariate analysis showed that the influencing factors of intracranial infection were:postoperative cerebrospinal fluid leakage,posterior cranial fossa surgical treatment,operation time exceeding 4 h,ventricular drainage,implantation of materials into the skull,diabetes,and central nervous system complicated infection diseases.Conclusion In clinical treatment,the operation time should be minimized,cerebrospinal fluid leakage should be avoided,the time of ventricular drainage should be shortened as much as possible,artificial implantable materials should be avoided as much as possible,and blood glucose should be effectively controlled,and sys temic infections should be effectively controlled and prevented;and meeting the above can greatly reduce the incidence of intracranial infection.