重型颅脑损伤患者开颅术后颅内感染的影响因素以及耐药性研究

Research on Factors and Drug Resistance of Intracranial Infection after Craniotomy in Patients with Severe Craniocerebral Trauma

目的研究分析重型颅脑损伤患者开颅术后颅内感染的影响因素以及耐药性。方法回顾我院2016年1月～2018年6月期间收治的150例重型颅脑损伤行开颅手术治疗患者的临床资料,探讨重型颅脑损伤患者开颅手术后发生颅内感染的影响因素,并对感染患者进行病原菌培养,分析其耐药性。结果 150例重型颅脑损伤患者术后发生颅内感染的有16例,感染率为10.67%;颅内感染患者脑脊液培养出病原菌16株,其中革兰阳性菌10株,革兰阴性菌6株;经Logistic回归分析结果显示手术时间(≥4h)、手术次数(≥2)、切口脑脊液漏和脑室外引流是影响患者开颅术后发生颅内感染的独立危险因素,差异具有统计学意义(P<0.05)。结论开颅手术后颅内感染患者以革兰阳性菌和革兰阴性菌较为多见,手术时间长、手术次数多、存在切口脑脊液漏或脑室外引流患者发生颅内感染的机率较高。

Objective This study aimed to study the factors affecting intracranial infection after craniotomy in patients with severe craniocerebral trauma and the drug resistance.Methods A total of 150 patients who underwent craniotomy for severe craniocerebral trauma in our hospital from January 2013 to March 2016,were reviewed to explore the influencing factors of intracranial infection after craniotomy in patients with severe craniocerebral trauma,and to cultivate pathogenic bacteria in patients with craniotomy and analyze their drug resistance.Results There were 16 cases of intracranial infection in 150 patients with severe craniocerebral trauma,and the infection rate was 10.67%.Sixteen strains of pathogenic bacteria were cultured in cerebrospinal fluid of patients with intracranial infection,including 10 strains of gram-positive bacteria and 6 strains of gram-negative bacteria.The results of Logistic regression analysis showed that operation time(≥4 h),operation times(≥2),incisional cerebrospinal fluid leakage and ventricular external drainage were independent risk factors for intracranial infection after craniotomy,and the difference had statistical significance(P<0.05).Conclusion Patients with intracranial infection after craniotomy are more likely to have intracranial infection with gram-positive bacteria and gram-negative bacteria,with longer operation time,more operation times,and the presence of incision cerebrospinal fluid leakage or external ventricular drainage.