创伤性脑积水脑室-腹腔分流术后并发感染的危险因素分析

Risk factors for postoperative infection in patients with post-traumatic hydrocephalus after ventriculoperitoneal shunt

目的探讨创伤性脑积水(PTH)病人脑室-腹腔分流术(VPS)后发生感染的危险因素。方法回顾性分析2015年5月至2020年5月VPS治疗的250例PTH的临床资料。术后随访1年,评估感染情况,包括VPS相关的颅内感染、切口感染、腹腔感染。采用多因素logistic回归模型分析术后感染的危险因素,并构建列线图模型,采用受试者工作特征(ROC)曲线评估模型的预测效能。结果术后随访1年,32例(12.8%)发生感染,其中8例脑室端感染,14例腹腔端感染,3例腹腔假性囊肿,7例感染后脑脊液蛋白及纤维素含量过高引起分流管阻塞;表皮葡萄球菌16例,金黄色葡萄球菌7例,革兰氏阴性菌6例,其他细菌3例;31例治愈,1例因其他疾病死亡。多因素logistic回归分析显示,年龄≥60岁(OR=0.366,95%CI 0.153~0.877,P=0.024)、合并糖尿病(OR=0.153,95%CI 0.053~0.445,P=0.001)、去骨瓣减压术(OR=0.213,95%CI 0.084~0.536,P=0.001)、分流管暴露时间≥30 min(OR=0.178,95%CI 0.071~0.446,P<0.001)是PTH病人VPS后出现感染的独立危险因素。根据这6个危险因素构建预测感染的列线图总分为330分,当分值>180分时,PTH病人VPS后感染的风险预测值>90%;ROC曲线分析显示列线图曲线下面积值显著高于单一指标(P<0.05)。结论高龄、糖尿病、去骨瓣减压术及分流管暴露时间长是PTH病人VPS后发生感染的高危因素,根据这些高危因素构建的列线图模型具有较好的预测价值,可为PTH病人VPS后感染的临床预判与治疗提供参考。

Objective To investigate the risk factors of postoperative infection in patients with post-traumatic hydrocephalus(PTH)after ventriculoperitoneal shunt(VPS).Methods The clinical data of 250 patients with PTH treated with VPS from May 2015 to May 2020 were retrospectively analyzed.The patients were followed up for 1 year to evaluate the infection status,including VPS-related intracranial infection,incision infection,and abdominal infection.Multivariate logistic regression model was used to analyze the risk factors of postoperative infection,and a nomogram model was constructed.Receiver operating characteristic(ROC)curve was used to evaluate the predictive efficacy of the nomogram model.Results Of these 250 patients,32 patients(12.8%)suffered from postoperative infection,of which 8 patients were intraventricular infection,14 intraperitoneal infection,3 intraperitoneal pseudocysts,and 7 shunt tube obstruction caused by high levels of protein and cellulose in cerebrospinal fluid.Sixteen patients were infected with Staphylococcus epidermidis,7 with Staphylococcus aureus,6 with gram-negative bacteria,and 3 with other bacteria.Thirty-one patients were cured and one died of other diseases.Multivariate logistic regression analysis showed that age≥60 years(OR=0.366,95%CI 0.153~0.877,P=0.024),diabetes(OR=0.153,95%CI 0.053~0.445,P=0.001),decompressive craniotomy(OR=0.213,95%CI 0.084~0.536,P=0.001),shunt exposure time≥30 min(OR=0.178,95%CI 0.071~0.446,P<0.001)were independent risk factors for infection in PTH patients after VPS.A nomogram model was constructed based on these 6 risk factors,and the total score of the model for predicting infection was 330.When the score was>180,the risk of infection in PTH patients after VPS was>90%.ROC curve analysis showed that the area value under the curve of the model was significantly higher than that of any single risk factor(P<0.05).Conclusions Elder age,diabetes mellitus,decompressectomy and long shunt exposure time are high risk factors for infection in PTH patients after VPS.The nomogram model constructed according to these high risk factors has good predictive value,and can provide reference for clinical prediction and treatment of infection in PTH patients after VPS.