开颅手术患者颅内感染的影响因素及脑脊液炎症因子水平

Influencing factors for intracranial infection and inflammatory factors in cerebrospinal fluid of patients undergoing craniotomy

目的 开颅手术患者颅内感染的影响因素及脑脊液中炎症因子水平。方法 回顾性分析2017年1月-2020年1月于天津市环湖医院进行开颅手术的1 845例患者的临床资料,依据是否出现术后颅内感染分为感染组95例和非感染组1 750例,分析感染病原菌分布,单因素和多因素Logistic回归分析开颅术后颅内感染的影响因素。结果 95例开颅术后颅内感染患者脑脊液标本共分离出134株病原菌,其中革兰阳性菌83株(61.94%),革兰阴性菌45株(33.58%),真菌4株(4.48%);多因素Logistic回归分析结果显示,开颅手术时间、急性生理与慢性健康(APACHE-Ⅱ)评分、脑脊液白细胞水平、脑脊液乳酸水平、脑脊液PCT水平、脑脊液CRP水平是开颅术后颅内感染的独立影响因素(P<0.05)。结论 开颅手术时间、APACHE-Ⅱ评分、脑脊液白细胞、乳酸、PCT、CRP水平是开颅术后颅内感染的影响因素,颅内感染或可通过监测脑脊液白细胞水平、乳酸水平、PCT、CRP水平进行预测。

OBJECTIVE To explore the influencing factors for intracranial infection in patients undergoing craniotomy and analyze the levels of inflammatory factors in cerebrospinal fluid.METHODS The clinical data of 1 845 patients who underwent craniotomy in Tianjin Huanhu Hospital from Jan 2017 to Jan 2020 were retrospectively analyzed,the patients were divided into the infection group with 95 cases and the no infection group with 1 750 cases according to the status of postoperative intracranial infection.The distribution of pathogens causing infection was observed,univariate analysis and multivariate logistic regression analysis were performed for the influencing factors for postoperative intracranial infection.RESULTS A total of 134 strains of pathogens were isolated from cerebrospinal fluid specimens of 95 craniotomy patients with postoperative intracranial infection,83(61.94%) of which were gram-positive bacteria,45(33.58%) were gram-negative bacteria,and 4(4.48%) were fungi.The result of multivariate logistic regression analysis showed that duration of craniotomy,APACHE-Ⅱ score,cerebrospinal fluid white blood cell level,cerebrospinal fluid lactic acid level,cerebrospinal fluid PCT level and cerebrospinal fluid CRP level were the independent influencing factors for the postoperative intracranial infection in the patients undergoing craniotomy(P<0.05).CONCLUSION The duration of craniotomy,APACHE-Ⅱ score,cerebrospinal fluid white blood level,lactic acid level,PCT level and CRP level are the influencing factors for the postoperative intracranial infection,and the levels of cerebrospinal fluid white blood cell,lactic acid,PCT and CRP may be used for prediction of intracranial infection.