脑出血患者术后颅内感染的危险因素分析

Analysis of risk factors of intracranial infection in patients with cerebral hemorrhage after operation

目的探讨脑出血患者术后颅内感染的危险因素。方法本研究为回顾性病例对照研究,选取2017年1月至2022年7月在百色市人民综合重症监护病房一区和神经外科重症监护病房住院治疗的1397例脑出血术后患者,男735例,女662例,年龄(68.15±9.68)岁,年龄范围为39~82岁。根据患者术后是否发生颅内感染将所有患者分为感染组(n=55)与非感染组(n=1342)。采用多因素和单因素logistic分析患者术后颅内感染的危险因素。结果格拉斯哥昏迷指数(GCS)评分≤8分(OR=4.427)、开颅手术(OR=8.118)、引流管留置时间在7 d以上(OR=12.150)、引流管位于脑室系统(OR=51.300)是术后并发颅内感染的主要危险因素。无基础疾病(OR=0.086)和非侵入性操作(OR=0.059)是术后并发颅内感染的保护因素。颅内感染的致病菌多种多样,主要分为革兰阳性菌、格兰阴性菌和真菌。结论GCS评分≤8分,开颅手术、引流管留置时间超过7 d、引流管位于脑室系统、合并基础疾病和有侵入性操作的脑出血患者术后并发颅内感染的风险较高,医护人员应制定相关的防控措施,以降低患者术后颅内感染的发生率。

Objective To investigate the risk factors of intracranial infection in patients with cerebral hemorrhage after operation.Methods This study was a retrospective case-control study,a total of 1397 patients hospitalized in Medical Intensive Care Unit District 1 and Neurosurgery Intensive Care Unit of Baise People's Hospital from January 2017 to July 2022 after intracerebral hemorrhage surgery were selected,including 735 males and 662 females,aged(68.15±9.68)years old,ranging from 39 to 82 years old.All patients were divided into infected group(n=55)and non-infected group(n=1342)according to whether intracranial infection occurred after surgery.Multivariate and univariate logistic analysis were used to analyze the risk factors for postoperative intracranial infection.Results The main risk factors for postoperative intracranial infection include Glasgow Coma Scale(GCS)score≤8 points(OR=4.427),craniotomy(OR=8.118),drainage tube placement duration exceeding 7 days(OR=12.150),and drainage tube located in the ventricular system(OR=51.300).No underlying disease(OR=0.086)and non-invasive operation(OR=0.059)are protective factors for postoperative intracranial infection.The pathogenic bacteria of intracranial infection are diverse,mainly including gram-positive bacteria,gram-negative bacteria and fungi.Conclusions Patients with a GCS score≤8 points,craniotomy,drainage tube placement duration exceeding 7 days,drainage tube located in the ventricular system,underlying diseases,and invasive operations have a higher risk of postoperative intracranial infection in patients with cerebral hemorrhage.Healthcare providers should develop relevant control measures to reduce the incidence of postoperative intracranial infections in patients.