影响神经外科手术后中枢神经系统感染发生的危险因素分析

Risk factors for postoperative central nervous system infection

目的探讨影响神经外科手术后中枢神经系统感染(PCNSI)发生的危险因素,为PCNSI的防治提供参考。方法收集南方医科大学珠江医院神经外科自2015年2月1日至2015年12月30日行手术治疗的397例神经外科疾病患者(共403次手术)的临床资料,分析PCNSI的发生率以及采用单因素分析、多因素Logistic回归分析筛选影响PCNSI发生的危险因素,并计算研究期间手术次数≥8次的12名主刀医生的手术医生调正PCNSI专率以评估主刀医生对PCNSI发生的影响。结果397例患者403次手术后PCNSI的发生率为9.2%(37例次),脑脊液细菌培养阳性率为29.7%(11/37),其中54.6%(6/11)为革兰氏染色阳性。单因素分析显示,与非PCSNI组(366例次)相比,PCSNI组(37例次)患者的美国国家医院感染监测(NNIS)评分更高、术前住院时间>6 d者比例更高、手术时间更长以及研究期间手术次数<8次的台上护士参与比例更高,差异均有统计学意义(P<0.05)。多因素Logistic回归分析显示,手术时间(OR=1.389,95%CI:1.202~1.606,P=0.000)以及研究期间手术次数<8次的台上护士参与(OR=2.860,95%CI:1.276~6.412,P=0.011)是影响PCSNI发生的独立危险因素。经NNIS评分调整后,12名主刀医生的手术医生调正PCNSI专率分别为20.0%、23.0%、17.3%、18.2%、13.4%、12.5%、6.3%、8.0%、5.2%、4.0%、0.0%、0.0%,其间差异性较大。结论对手术医生调正PCNSI专率高的主刀医生进行专项感控培训指导、减少手术时间、培养神经外科手术专科护士将是降低PCNSI发生的重要举措。

Objective To clarify the risk factors for post-operative central nervous system infection(PCNSI)to provide references for prevention and treatment of PCNSI.Methods A total of 397 patients with neurosurgery diseases,admitted to and accepted 403 surgeries in our hospital from February 1st,2015 to December 30th,2015,were chosen in our study;their clinical data were collected.The incidence of PCNSI was analyzed.Risk factors for PCNSI were analyzed by univariate analysis and multivariate Logistic regression analysis.The ajusted specific infection rate of PCNSI was calculated in 12 chief surgeons who performed≥8 operations during the study period to assess the influence of surgeons in PCNSI incidence.Results The PCNSI incidence in these 397 patients was 9.2%(37/403).The cerebrospinal fluid(CSF)culture positive rate was 29.7%(11/37),including 6(54.6%)with positive gram staining.Univariate analysis showed that as compared with the non-infected group(366 surgeries),patients in the PCSNI group(37 surgeries)had significantly higher National Nosocomial Infections Surveillance(NNIS)scale,significantly higher proportion of patients with preoperative stay>6 d,significantly longer operative duration,and statistically higher proportion of involvement of scrub nurses with experience in fewer than 8 procedures(P<0.05).Multivariate Logistic regression analysis showed operative duration(OR=1.389,95%CI:1.202-1.606,P=0.000)and involvement of scrub nurses with experience in fewer than 8 procedures(OR=2.860,95%CI:1.276-6.412,P=0.011)were independent risk factors for PCNSI.After adjustment by NNIS scale,the ajusted specific infection rate of PCNSI in 12 chief surgeons was 20.0%,23.0%,17.3%,18.2%,13.4%,12.5%,6.3%,8.0%,5.2%,4.0%,0.0%,and 0.0%,respectively,enjoying obvious differences.Conclusion Specialized infection control training should give to surgeons with high adjusted specific infection rate of PCNSI;this training,shortening operative duration,and training of neurosurgery specialist nurses will be important measures to reduce PCNSI incidence.