成人脑积水患者脑室-腹腔分流术前脑脊液常规及生化指标与术后颅内感染的相关性研究

Correlations of cerebrospinal fluid routines and biochemical indexes before ventriculoperitoneal shunt with postoperative intracranial infection in adult patients with hydrocephalus

目的:探讨成人脑积水患者脑室-腹腔分流术前脑脊液常规及生化指标异常与术后颅内感染的相关性。方法:选择南方医科大学珠江医院神经外科中心功能神经外科自2016年1月至2021年12月行脑室-腹腔分流术的347例成人患者进行回顾性病例对照研究。根据术后是否出现颅内感染将患者分为感染组(27例)和非感染组(320例),分析比较2组患者一般临床资料及脑脊液常规、生化检验结果,采用多因素Logistic回归分析明确患者术前脑脊液中白细胞、氯、葡萄糖、乳酸和蛋白质等指标与术后颅内感染的相关性。结果:感染组与非感染组患者年龄、性别分布及原发病种类差异均无统计学意义(P>0.05)。与非感染组比较,感染组患者脑脊液中葡萄糖含量明显降低、乳酸含量明显升高,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示:葡萄糖含量、乳酸含量与脑室-腹腔分流术后颅内感染独立相关。相对术前脑脊液中葡萄糖含量≥2.5 mmol/L的患者,葡萄糖含量<2.5的患者术后出现颅内感染的几率为前者的21.825倍;相对术前脑脊液中乳酸含量≤2.5 mmol/L的患者,乳酸含量>2.5 mmol/L的患者术后出现颅内感染的几率为前者的18.430倍。结论:对于无颅内感染临床表现而仅单纯脑脊液异常的成人脑积水患者,当脑脊液葡萄糖含量<2.5 mmol/L、乳酸含量>2.5 mmol/L时,建议待脑脊液指标进一步改善后再行脑室-腹腔分流术,避免增加术后感染率。

Objective To study the correlations of cerebrospinal fluid(CSF)routines and biochemical indexes before ventriculoperitoneal shunt with postoperative intracranial infection in adult patients with hydrocephalus.Methods A retrospective case-control study was conducted on 347 adult patients who underwent ventriculoperitoneal shunt in Department of Functional Neurosurgery,Neurosurgery Center,Zhujiang Hospital of Southern Medical University from January 2016 to December 2021.According to the appearance of postoperative infection or not,these patients were divided into infection group(n=27)and non-infection group(n=320).General clinical data and CSF routines and biochemical indexes test results were analyzed and compared between the two groups.The correlations of postoperative intracranial infection with preoperative levels of white blood cells,chlorine,glucose,lactic acids and proteins in the CSF were analyzed by multivariate Logistic regression.Results There was no significant difference in age,gender,or primary diseases between infection group and non-infection group(P>0.05).As compared with the non-infection group,the infection group had significantly decreased glucose content and significantly increased lactic acid content in the CSF(P<0.05).Multivariate Logistic regression analysis showed that glucose content(OR=21.825,95%CI:4.994-95.394,P<0.001)and lactic acid content(OR=18.430,95%CI:6.023-56.391,P<0.001)were independently correlated with infections after ventriculoperitoneal shunt.Risk of patients with glucose content<2.5 to develop intracranial infection after surgery was 21.825 times that of patients with preoperative glucose content≥2.5 mmol/L.Risk of patients with lactic acid content>2.5 mmol/L to develop intracranial infection after surgery was 18.430 times that of patients with preoperative lactic acid content≤2.5 mmol/L.Conclusion For adult hydrocephalus patients without intracranial infection but only with abnormal CSF(glucose content<2.5 mmol/L or lactic acid content>2.5 mmol/L),ventriculoperitoneal shunt should only be performed after further improvement of CSF indexes to avoid increasing postoperative infection.