3D打印辅助微创治疗高血压脑出血颅内感染的影响因素及对策

 目的 分析3D打印辅助微创治疗高血压脑出血（HICH）术后颅内感染的影响因素，并探讨相应的预防对策，为术后颅内感染防控措施的制定提供依据。方法 回顾性分析2015年10月—2018年12月某综合三级甲等医院神经外科行3D打印辅助微创治疗HICH患者的临床资料（n=324），依据是否发生颅内感染分为感染组与非感染组，比较两组患者的一般资料、手术治疗过程等差异。结果 324例3D打印辅助微创治疗HICH患者，发生颅内感染32例，感染率为9.87%。颅内感染患者送检标本检出病原菌19株，其中革兰阴性菌9株（47.37%），革兰阳性菌8株（42.10%），真菌2株（10.53%）。3D打印辅助微创治疗HICH患者单因素分析结果显示，吸烟史、颅内出血量、术前备皮距手术时间、手术地点、手术持续时间、术后溶凝治疗次数、引流管留置时间、预防性使用抗菌药物8项因素比较，差异具有统计学意义（均P<0.05）；多因素logistic回归分析结果显示，预防性应用抗菌药物为预防颅内感染的保护性因素，而颅内出血量、术前备皮距手术时间、手术持续时间，引流管留置时间是发生颅内感染的独立危险因素。结论 3D打印辅助微创治疗HICH患者术后发生颅内感染是多种因素共同作用的结果，在围手术期重要环节采取有效的防控措施，是预防颅内感染的关键。

Influencing factors and countermeasures for intracranial infection after three-dimensional printing-assisted minimally invasive treatment for hypertensive intracerebral hemorrhage

Objective To analyze the influencing factors for post-operative intracranial infection after three-dimensional printing-assisted minimally invasive(3DP-MI) treatment for hypertensive intracerebral hemorrhage (HICH), explore the corresponding preventive measures, so as to provide basis for the formulation of prevention and control measures of post-operative intracranial infection. Methods Clinical data of 324 patients who underwent 3DP-MI treatment in neurosurgery department of a tertiary hospital from October 2015 to December 2018 were retrospectively analyzed, according to whether intracranial infection occurred, patients were divided into infection group and non-infection group, general information and surgical treatment course of two groups of patients were compared. Results Among 324 patients undergoing 3DP-MI treatment, 32 (9.87%) had intracranial infection. 19 strains of pathogens were isolated from specimens of patients with intracranial infection, including 9 strains (47.37%) of Gram-negative bacteria, 8 strains (42.10%) of Gram-positive bacteria, and 2 strains (10.53%) of fungi. Univariate analysis on HICH patients undergoing 3DP-MI treatment showed that differences in smoking history, intracranial hemorrhage volume, time from pre-operative skin preparation to operation, operation location, operation duration, times of post-operative thrombolytic therapy, indwelling time of drainage tube, and prophylactic use of antimicrobial agents were all significantly different (all P < 0.05); multivariate logistic regression analysis showed that prophylactic use of antimicrobial agents was the protective factor for the prevention of intracranial infection, while intracranial hemorrhage volume, time from pre-operative skin preparation to operation, operation duration, indwelling time of drainage tube were independent risk factors for intracranial infection. Conclusion Post-operative intracranial infection in HICH patients undergoing 3DP-MI treatment results from a variety of factors, the key to the prevention of intracranial infection is to take effective prevention and control measures during peri-operative period.