创伤性颅脑损伤患者术后并发颅内感染的影响因素分析

Analysis of Influencing Factors for Postoperative Complications of Intracranial Infection in Patients with Traumatic Craniocerebral Injury

目的:分析创伤性颅脑损伤(TBI)患者术后并发颅内感染(ICI)的影响因素,以降低术后ICI的发病风险。方法:选取2020年6月—2021年6月达州市中西医结合医院神经内科收治的213例TBI患者作为研究对象,经单因素及logistic多因素分析TBI患者术后并发ICI相关影响因素,术后对ICI进行病原菌培养统计TBI患者术后并发ICI的病原菌类型。结果:术后并发ICI的22例TBI患者纳入ICI组,剩余191例患者纳入无ICI组。将ICI组患者进行无菌操作取脑脊液进行病原菌培养,结果显示,ICI组患者中金色葡萄球菌7例(31.82%),表皮葡萄球菌6例(27.27%),凝固酶阴性葡萄球菌6例(27.27%),头葡萄球菌及纹带棒状杆菌各1例(4.55%)。TBI患者术后并发ICI可能与合并糖尿病、术前GCS评分、手术时间、坠积性肺炎、术后发生脑脊液漏及术后出现低蛋白血症有关,差异有统计学意义(χ^(2)=7.264、11.292、5.066、14.840、5.555、7.649,P<0.05)。经非条件logistic回归分析结果得出,合并糖尿病、术前GCS评分<8分、手术时间>4 h、坠积性肺炎、术后发生脑脊液漏及术后出现低蛋白血症均是影响TBI患者术后并发ICI的危险因素,差异有统计学意义(OR>1,P<0.05)。结论:合并糖尿病、术前GCS评分<8 min、手术时间>4 h、术后发生脑脊液漏及术后出现低蛋白血症均是影响TBI患者术后并发ICI的危险因素,临床需针对性上述因素进行合理干预以降低ICI的发生率。

Objective:To analyze the Influencing factors for postoperative complications of intracranial infection(ICI)in patients with traumatic brain injury(TBI)in order to reduce the risk of developing ICI after surgery.Methods:213 patients with TBI admitted to the hospital from June 2020 to June 2021 were selected for the study.The influencing factors related to postoperative complications of ICI in patients with TBI were analyzed by univariate and logistic multifactorial analysis,and the pathogenic bacteria types of postoperative complications of ICI in patients with TBI were counted by postoperative pathogenic culture of ICI.Results:There were 22 patients with postoperative complications of ICI in TBI,which were included in the ICI group,and the remaining 191 were included in the no-ICI group.Patients in the ICI group were subjected to aseptic procedures to obtain cerebrospinal fluid for pathogenic cultures,and the results showed that there were 7 cases of Staphylococcus aureus(31.82%),6 cases of Staphylococcus epidermidis(27.27%),6 cases of coagulase-negative staphylococci(27.27%),and 1 case each of Staphylococcus cephalis and striated rod-shaped bacilli(4.55%)in the ICI group.Postoperative complications of ICI in patients with TBI may be associated with comorbid diabetes mellitus,preoperative GCS score,duration of surgery,crushing pneumonia,postoperative occurrence of cerebrospinal fluid leakage and postoperative development of hypoproteinemia,with statistically significant differences(χ^(2)=7.264,11.292,5.066,14.840,5.555,7.649,P<0.05).The results of unconditional logistic regression analysis concluded that combined diabetes mellitus,preoperative GCS score<8,operative time>4 h,crushing pneumonia,occurrence of postoperative cerebrospinal fluid leak and postoperative hypoproteinemia were all risk factors for postoperative complications of ICI in patients with TBI,with statistically significant differences(OR>1,P<0.05).Conclusion:Combined diabetes mellitus,preoperative GCS score<8 min,operation time>4 h,postoperative cerebrospinal fluid leakage and postoperative hypoproteinemia are all risk factors for postoperative complications of ICI in patients with TBI,and reasonable clinical interventions are needed to reduce the incidence of ICI by targeting these factors.