高血压脑出血患者血肿清除术后颅内感染的病原菌及危险因素

Pathogenic bacteria and risk factors for intracranial infection in patients with hypertensive intracerebral hemorrhage after hematoma removal

目的 分析高血压脑出血患者血肿清除术后颅内感染的病原菌特征及危险因素回归方程。方法 选取2020年1月-2022年6月江南大学附属医院收治的154例接受血肿清除术治疗的高血压脑出血患者纳入研究,回顾性收集患者临床资料,根据患者颅内感染情况将其分为感染组34例,未感染组120例。分析高血压脑出血患者血肿清除术后颅内感染的病原菌特征,通过单因素、多因素分析其影响因素并建立危险因素回归方程,采用受试者工作特征(ROC)曲线分析其预测价值。结果 154例高血压脑出血患者颅内感染34例,感染率为22.08%;34例高血压脑出血患者血肿清除术后颅内感染患者共分离出病原菌42株,其中革兰阳性菌26株,占比61.90%;多因素Logistic分析结果显示,格拉斯哥昏迷评分法(GCS)评分<8分、糖尿病、鞘内注射≥6次、引流管留置时间≥3 d、白蛋白水平(ALB)<35 g/L为高血压脑出血患者颅内感染的危险因素(P<0.05);将上述因素纳入影响因素模型:logit(P)=-13.435+0.739×GCS评分<8分+0.701×糖尿病+0.504×鞘内注射≥6次+0.798×引流管留置时间≥3 d+0.857×ALB<35 g/L,绘制ROC曲线的曲线下面积(AUC)为0.876,诊断灵敏度为86.00%、特异度为82.00%。结论 高血压脑出血患者血肿清除术后颅内感染主要病原菌为革兰阳性菌,危险因素较多,构建危险因素回归方程对高血压脑出血患者血肿清除术后颅内感染预测价值高。

OBJECTIVE To analyse the pathogenic bacteria and regression equation of risk factors of intracranial infection after hematoma removal in patients with hypertensive intracerebral hemorrhage.METHODS From Jan 2020 to Jun 2022,154 patients with hypertensive cerebral hemorrhage who received hematoma removal operation in the Affiliated Hospital of Jiangnan University were included in the study.Clinical data of the patients were retrospectively collected.According to whether intracranial infection occurred,patients were divided into the infected group(34 cases)and the non-infected group(120 cases).The pathogenic bacteria characteristics of intracranial infection after hematoma removal in patients with hypertensive intracerebral hemorrhage were analyzed,and the influencing factors for intracranial infection after hematoma removal in patients with hypertensive intracerebral hemorrhage was analyzed by univariate and multivariate analysis.The regression equation of risk factors was established,and receiver operating characteristic curve(ROC)was used to analyze the predictive value of logistic regression equation for intracranial infection in patients with hypertensive intracerebral hemorrhage after hematoma removal.RESULTS Thirty-four in 154 patients with hypertensive intracerebral hemorrhage were infected after operation,with the infection rate of 22.08%.A total of 42 strains of pathogenic bacteria were isolated from 34 patients with intracranial infection after hematoma removal,including 26 strains of gram-positive bacteria,accounting for 61.90%.Multivariate logistic analysis showed that score of Glasgow coma scale(GCS)<8 point,diabetes mellitus,intrathesal injection≥6 times,catheter indwelling time≥3 d,albumin(ALB)<35 g/L were the risk factors for intracranial infection in patients with hypertensive intracerebral hemorrhage(P<0.05).The above factors were included in the influencing factor model:logit(P)=-13.435+0.739 X score of GCS<8 points+0.701X diabetes+0.504X intratheral injection≥6 times+0.798X catheter indwelling time≥3 days+0.857X ALB<35 g/L.The the area under the curve(AUC)of ROC was 0.876,with the diagnostic sensitivity of 86.00%and the specificity of 82.00%.CONCLUSION The main pathogenic bacteria of intracranial infection after hematoma removal in patients with hypertensive cerebral hemorrhage were gram-positive bacteria.There were many risk factors for intracranial infection in patients with hypertensive intracerebral hemorrhage.The construction of regression equation of risk factors shows high value in predicting intracranial infection after removal of hematoma in patients with hypertensive intracerebral hemorrhage.