世居高原开颅手术后患者医院感染的相关因素分析

doi:10.3969/j.issn.1671-7171.2019.03.012

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摘要【目的】分析世居高原患者开颅手术后医院感染的相关因素。【方法】回顾性分析2010年7月至2018年7月本院收治的227例因创伤、肿瘤和其他颅内疾病行开颅手术患者的临床资料,统计患者术后医院感染的发生情况、感染类型及病原菌分布,比较患者一般临床资料,采用Logistic多因素回归分析方法,分析影响患者医院感染的相关因素,并总结其临床预防对策。【结果】227例患者中共有59例于开颅手术后发生医院感染,发生率为25.99%,患者感染部位以肺内为主(45.76%),其次为颅内感染(30.51%)。59例患者共检出病原菌77株,其病原菌以鲍氏不动杆菌为主(44.16%),其次为表皮葡萄球菌(19.48%)。Logistic多因素回归分析显示,年龄＞50岁、手术时间≥4 h、开放性损伤、拔管时间≥3 h是影响世居高原患者开颅手术后医院感染的独立危险因素(P<0.05)。【结论】世居高原患者开颅手术后医院感染的发生率较高且影响因素复杂;重视其高危患者的评估并落实清创、无菌操作、围术期管理,针对性护理等措施,是预防医院感染、提高神经外科手术安全性的关键所在。

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	王军
	刘俊峰
	李昌泰

关键词 ：颅骨切开术/副作用, 人口特征

Abstract：【Objective】To analyze the related factors of nosocomial infection after craniotomy in patients living at high altitude. 【Methods】The clinical data of 227 patients undergoing craniotomy due to trauma, tumors and other intracranial diseases from July 2010 to July 2018 were retrospectively analyzed. The incidence of nosocomial infection, types of infection and distribution of pathogenic bacteria were analyzed. The general clinical data of patients were compared. Logistic multivariate regression analysis was used to analyze the related factors affecting nosocomial infection of patients. The clinical preventive measures were summarized.【Results】Of the 227 patients, 59 had nosocomial infection after craniotomy, the incidence was 25.99%. The main site of infection was in the lungs (45.76%), followed by intracranial infection (30.51%). A total of 77 strains of pathogenic bacteria were detected in 59 patients. Acinetobacter baumannii was the main pathogen (44.16%), followed by Staphylococcus epidermidis (19.48%). Logistic multivariate regression analysis showed that age > 50 years old, operation time (≥4 hours), open injury and extubation time (≥3 hours) were independent risk factors for nosocomial infection after craniotomy in plateau patients (P<0.05).【Conclusion】The incidence of nosocomial infection after craniotomy in patients in plateau area is high and the influencing factors are complex. The key to prevent nosocomial infection and improve the safety of neurosurgery is to pay attention to the evaluation of high-risk patients, implement debridement, aseptic operation, perioperative management and targeted nursing.

Key words： Craniotomy/AE Population Characteristics

收稿日期: 2019-01-11

PACS:

R651.1

引用本文:

王军, 刘俊峰, 李昌泰. 世居高原开颅手术后患者医院感染的相关因素分析[J]. 医学临床研究, 2019, 36(3): 451-454.
WANG Jun, LIU Jun-feng, LI Chang-tai. Analysis of Related Factors of Nosocomial Infection in Patients after Craniotomy at High Altitude. JOURNAL OF CLINICAL RESEARCH, 2019, 36(3): 451-454.

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http://journal07.magtech.org.cn/yxlcyj/CN/10.3969/j.issn.1671-7171.2019.03.012 或 http://journal07.magtech.org.cn/yxlcyj/CN/Y2019/V36/I3/451

[1] Kohler RJ, Arnold SA, Eck DJ,et al. Incidence of and risk factors for major complications or death in dogs undergoing cytoreductive surgery for treatment of suspected primary intracranial masses[J].J Am Vet Med Assoc,2018, 253(12): 1594-1603.
[2] 马艳芳,陈亮,侯伟丽,等.患者开颅术后颅内感染相关因素调查[J].中华医院感染学杂志, 2016, 26(11): 2485-2487.
[3] 邢永国, 孟伟英, 张淑祥, 等. 神经外科开颅术后颅内感染诊治新进展[J].中华医院感染学杂志, 2016, 26(22): 5268-5271.
[4] 中华人民共和国卫生部. 医院感染诊断标准(试行)[J].中华医学杂志, 2003, 81(7): 460-465.
[5] Elward A, Yegge J, Recktenwald A, et al. Risk factors for craniotomy or spinal fusion surgical site infection[J].Pediatr Infect Dis J,2015, 34(12): 1323-1328.
[6] 王庆宇, 杨玉芳, 徐少毅. 重症监护病房开颅术后患者颅内感染的调查[J].中华医院感染学杂志, 2017, 27(5): 1129-1132.
[7] Golebiowski A, Drewes C, Gulati S, et al. Is duration of surgery a risk factor for extracranial complications and surgical site infections after intracranial tumor operations[J]?Acta Neurochir(Wien),2015, 157(2): 235-240.
[8] 刘洛同, 周杰, 明扬, 等. 开颅手术及脑脊液分流术后颅内感染危险因素分析[J].成都医学院学报, 2015, 10(2): 222-224.
[9] Lin C, Zhao X, Sun H. Analysis on the risk factors of intracranial infection secondary to traumatic brain injury[J].Chin J Traumatol,2015, 18(2): 81-83.
[10] Gessler F, Bruder M, Duetzmann S, et al. Risk factors governing the development of cerebral vein and dural sinus thrombosis after craniotomy in patients with intracranial tumors[J].J Neurosurg,2018, 128(2): 373-379.
[11] 高川. 开颅手术后继发颅内感染的危险因素和治疗方法[J].中国继续医学教育, 2015, 7(1): 46-47.
[12] Tsang ACO, Hui VKH, Lui WM, et al. Complications of post-craniectomy cranioplasty: risk factor analysis and implications for treatment planning[J].J Clin Neurosci,2015, 22(5): 834-837.
[13] 杨继玮. 脑外伤开颅术后颅内感染发生的危险因素分析[J].中国实用神经疾病杂志, 2016, 19(5): 90-91.
[14] 袁乔红, 毛胜. 开颅术后颅内感染的危险因素及防治措施[J].世界最新医学信息文摘, 2015, 14(11): 90-91.
[15] Cassir N, De La Rosa S, Melot A, et al. Risk factors for surgical site infections after neurosurgery: A focus on the postoperative period[J].Am J Infection Control,2015, 43(12): 1288-1291.
[16] 邓明均, 吴晓宏, 孙卫和. 脑外伤开颅术后颅内感染发生的相关危险因素研究[J].南通大学学报:医学版, 2016, 36(6): 631-632.
[17] Rosseto RS, Giannetti AV, de Souza Filho LD, et al. Risk factors for graft infection after cranioplasty in patients with large hemicranial bony defects[J].World Neurosurg, 2015, 84(2): 431-437.