重症颅脑损伤患者行去骨瓣减压术后发生院内感染的危险因素

Risk Factors of Nosocomial Infection in Patients with Severe Craniocerebral Injury after Decompressive Craniectomy

目的:探讨重症颅脑损伤患者行去骨瓣减压术后发生院内感染的危险因素。方法:选取2019年7月-2021年2月台山市人民医院神经外科收治的224例重症颅脑损伤患者为研究对象。根据是否发生院内感染将患者分为感染组和未感染组,比较两组临床资料,感染组进行病原菌采集和分离鉴定。采用logistic回归分析重症颅脑损伤患者行去骨瓣减压术后发生院内感染的危险因素。结果:224例患者中共有39例出现院内感染,感染率为17.4%。病原菌分离鉴定显示,39例患者共检出56株病原菌,其中革兰阴性菌35株(62.5%),革兰阳性菌18株(32.1%),真菌3株(5.4%)。重症颅脑损伤患者行去骨瓣减压术后发生院内感染与基础疾病、手术时间、ICU滞留时间、GCS评分、插管操作、预防性使用抗菌药物、损伤类型、脑脊液漏有关(P<0.05)。手术时间≥3 h、ICU滞留时间≥7 d、插管操作、开放性损伤、脑脊液漏是导致重症颅脑损伤患者术后发生院内感染的独立危险因素(OR>1,P<0.05),而预防性使用抗菌药物是保护因素(OR<1,P<0.05)。结论:重症颅脑损伤患者行去骨瓣减压术后发生院内感染的因素较多,临床应当制定针对性的预防措施干预,降低感染的发生。

Objective:To explore the risk factors of nosocomial infection in patients with severe craniocerebral injury after decompressive craniectomy.Method:A total of 224 patients with severe craniocerebral injury admitted to the Department of Neurosurgery of Taishan People’s Hospital from July 2019 to February 2021 were selected as the research subjects.Patients were divided into infected group and non-infected group according to whether nosocomial infection occurred.Clinical data of the two groups were compared,and pathogenic bacteria were collected,isolated and identified in the infected group.logistic regression was used to analyze the risk factors of nosocomial infection after craniocerebral decompression.Result:Nosocomial infection occurred in 39 of 224 patients,with an infection rate of 17.4%.Isolation and identification of pathogenic bacteria showed that a total of 56 pathogenic bacteria were detected from 39 patients,including 35 strains (62.5%) Gram-negative bacteria,18 strains (32.1%) Gram-positive bacteria and 3 strains (5.4%) fungi.Nosocomial infection in patients with severe craniocerebral injury after decompression was related to basic diseases,operation time,ICU stay time,GCS score,intubation operation,prophylactic use of antibiotics,injury type and cerebrospinal fluid leakage (P<0.05).Operation time ≥3 h,ICU stay time ≥7 d,intubation operation,open injury and cerebrospinal fluid leakage were independent risk factors for nosocomial infection after severe craniocerebral injury (OR>1,P<0.05),while preventive use of antibiotics was protective factors (OR<1,P<0.05).Conclusion:There are many factors of nosocomial infection in patients with severe craniocerebral injury after decompressive craniectomy,and clinical prevention measures should be formulated to reduce the occurrence of infection.