前交通动脉瘤开颅夹闭术后颅内感染危险因素及血清与脑脊液UA、LDH诊断价值研究

Risk factors of intracranial infection after craniotomy for nterior communicating aneurysm clipping and the diagnostic value of UA and LDH in serum and cerebrospinal fluid

目的探究前交通动脉瘤开颅夹闭术后颅内感染的危险因素及血清与脑脊液尿酸(UA)、乳酸脱氢酶(LDH)的诊断价值。方法回顾性分析绵阳市中心医院神经外科自2010年8月至2017年3月收治的140例前交通动脉瘤开颅夹闭术患者,根据是否发生颅内感染将患者分为颅内感染组和非颅内感染组,对患者的基础资料及血清与脑脊液UA、LDH进行多因素分析,同时对血清与脑脊液UA、LDH单独检测和联合检测的诊断效能进行比较。结果颅内感染组28例,非颅内感染组112例,2组患者的糖尿病史、术中动脉瘤破裂、术后脑脊液漏、术中出血量>100 mL占比比较,差异均具有统计学意义(P<0.05);颅内感染组患者的术后血清及脑脊液UA、LDH水平显著高于非颅内感染组,差异具有统计学意义(P<0.05)。进一步Logistic分析结果显示,糖尿病史、术中动脉瘤破裂、术后脑脊液漏、术中出血量>100 mL、血清及脑脊液UA、LDH水平均为颅内感染的独立危险因素。通过受试者工作特征曲线分析,脑脊液UA、脑脊液LDH、血清UA、血清LDH的临界值分别为23.14μmol/L、311.29 U/L、22.91μmol/L、273.11 U/L。结论前交通动脉瘤夹闭术后,患者的高血糖状态、术中动脉瘤破裂、术中脑脊液漏、术中出血量>100 mL均为患者颅内感染的独立危险因素,且通过对患者的脑脊液以及血清UA、LDH的检测,可对颅脑感染做出早期诊断。

Objective To explore the risk factors of intracranial infection after craniotomy for nterior communicating aneurysm clipping and the diagnostic value of uric acid(UA)and lactic dehydrogenase(LDH)in serum and cerebrospinal fluid.Methods One hundred and forty patients with anterior communicating aneurysms admitted in Neurosurgery Department of Mianyang Central Hospital from August 2010 to March 2017 were retrospectively analyzed.According to the occurrence of intracranial infection,the patients were divided into intracranial infection group and non-intracranial infection group.The basic data,serum and cerebrospinal fluid UA and LDH were analyzed.The diagnostic efficacy of the serum and cerebrospinal fluid UA and LDH detection alone and combined was compared.Results There were 28 cases in intracranial infection group and 112 cases in non intracranial infection group.There were significant differences between diabetes history,intraoperative aneurysm rupture,postoperative cerebrospinal fluid leakage,and intraoperative hemorrhage volume(P<0.05).The levels of UA and LDH in postoperative serum and the cerebrospinal fluid of intracranial infection group were significantly higher than those in non intracranial infection group(P<0.05).Further Logistic analysis showed that diabetes history,intraoperative aneurysm rupture,postoperative cerebrospinal fluid leakage,intraoperative hemorrhage volume>100 mL,levels of UA and LDH in serum and cerebrospinal fluid were independent risk factors for intracranial infection.Through receiver operating characteristic curve analysis,the critical values of CSF UA,CSF LDH,serum UA and serum LDH were 23.14μmol/L,311.29 U/L,22.91μmol/L,273.11 U/L respectively.Conclusion After anterior communicating aneurysm clipping,the patient’s hyperglycemia,intraoperative aneurysm rupture,intraoperative cerebrospinal fluid leakage and intraoperative hemorrhage volume>100 mL are independent risk factors for intracranial infection.Early diagnosis of craniocerebral infection can be made by the detection of cerebrospinal fluid and serum UA and LDH.