Abstract：【Objective】 To investigate the risk factors for intracranial infection following artificial dura mater patch implantation (ADMP) and to establish a risk prediction model.【Methods】 The clinical data of 231 patients who underwent ADMP were retrospectively analyzed. Multivariate logistic regression analysis was used to identify independent risk factors for postoperative intracranial infection, and a nomogram prediction model was constructed based on the results. The model's performance was evaluated using the receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA).【Results】 Among the 231 patients, 23 cases (9.96%) developed intracranial infection. Multivariate logistic regression analysis revealed that prolonged operative time, graft type, preoperative infection history, and cerebrospinal fluid (CSF) leakage were independent risk factors for postoperative intracranial infection (P<0.05). The nomogram model demonstrated an area under the curve (AUC) of 0.933. The calibration curve indicated good agreement between predicted and observed risks of intracranial infection. Decision curve analysis showed that the model could effectively improve the accuracy of clinical decision-making.【Conclusion】 Prolonged operative time, graft type, preoperative infection history, and CSF leakage significantly increase the risk of intracranial infection after ADMP. The prediction model based on these factors exhibits good discrimination and calibration, providing valuable reference for early identification of high-risk patients and optimization of clinical management strategies.
[1] 陈明宇,徐健,徐铭,等. 应用人脱细胞同种异体真皮基质材料修补硬脑膜缺损的随机对照研究[J].中华神经外科杂志,2022,38(12):1249-1253. [2] ZENG T, WANG M S, XU Z J, et al. Autologous free fascia lata can be used as dura graft in the salvage treatment of recalcitrant postcraniotomy intracranial infection caused by multidrug-resistant gram-negative bacteria[J].Infect Drug Resist,2022,15:5667-5677. [3] 王亮,刘南,高本林. 后颅窝肿瘤手术后颅内感染临床特征分析[J].医学临床研究,2019,36(4):687-688. [4] 张施远,石海平,曾春,等. Ⅰ类切口开颅术后颅内感染的相关危险因素分析[J].医学临床研究,2022,39(4):481-483. [5] 中国医师协会神经外科医师分会,中国神经创伤专家委员会. 中国颅脑创伤外科手术指南[J].中华神经外科杂志,2009,25(2):100-101. [6] TSITSOPOULOS P P, IOSIFIDIS E, ANTACHOPOULOS C, et al. Nosocomial bloodstream infections in neurosurgery: a 10-year analysis in a center with high antimicrobial drug-resistance prevalence[J].Acta Neurochir(Wien),2016,158(9):1647-1654. [7] VAN DOORMAAL T, GERMANS M R, SIE M, et al. Single-arm, open-label, multicentre first in human study to evaluate the safety and performance of dural sealant patch in reducing CSF leakage following elective cranial surgery: the ENCASE trial[J].BMJ Open,2021,11(7):e049098. [8] 李媛. 颅内动脉瘤术后继发颅内感染的相关危险因素分析及其防治对策[D]. 合肥:安徽医科大学,2024. [9] YANG W J, WU X, LI Z Q, et al. Trends of intra-cranial bacterial infection in patients requiring emergency neurosurgery[J].Surg Infect(Larchmt),2020,21(8):677-683. [10] 韩广信,王昌盛. 神经外科Ⅰ类切口手术预防使用抗菌药物情况调查及术后颅内感染影响因素分析[J].中国处方药,2024,22(9):46-49. [11] 韩路懿,宋子豪,王佳晨,等. 硬脑膜修复复合材料的研究进展[J].中华生物医学工程杂志,2023,29(6):694-698. [12] ZHAO Y, CHEN L, ZHANG J S, et al. Duraplasty with cervical fascia autograft to reduce postoperative complications of posterior fossa tumor surgery with suboccipital midline approach[J].World Neurosurg,2020,134:e1115-e1120. [13] YANG H A, SUN S C, ZHENG X R, et al. Effect of subdural muscle packing in repairing dura mater after retrosigmoid craniotomy[J].J Int Med Res,2020,48(3):300060520910299. [14] 谢勇,向迅捷,徐才邦,等. 脑积水性脑室-腹腔分流术诱发颅内感染的病原菌构成及危险因素分析[J].海军医学杂志,2022,43(3):318-322. [15] 黄欢,茅帅东,秦家骏,等. 外伤性脑脊液漏并发颅内感染的危险因素研究[J].同济大学学报(医学版),2024,45(1):87-93.
2025, Vol. 42 
