儿童开颅术后脑脊液外引流与颅内感染的相关性研究

目的 探讨儿童开颅术后脑脊液外引流与颅内感染的相关性。方法 回顾性分析2018年12月至2019年9月间因颅内幕上病变于首都医科大学附属北京天坛医院神经外科小儿病区行开颅手术的253例儿童患者的临床资料。结果 253例儿童中113例患儿于术后留置脑脊液外引流管,术后外引流管的留置时间平均为9 d(2~23 d)。253例患儿术后颅内感染发生率为30%(76/253),留置外引流管患儿术后颅内感染发生率为54%(61/113),单因素分析(χ²=55.702,P<0.001)及多因素分析(OR=8.045, 95% CI:4.121~15.703,P<0.001)显示,外引流管留置是颅内感染的独立危险因素。113例患儿中,41例患儿术后开放脑脊液外引流系统,统计显示脑脊液引流系统开放组的颅内感染率较未开放组高(75.6% vs 41.6%,χ²=12.116, P<0.001)。颅内感染发生率与引流时间呈正比,第5天拔管者,其对应的感染率及累及感染率为最低,分别为25%和27%。颅内感染的患儿1周内拔管组的抗感染时间及术后住院时间均短于引流管留置1周以上者(9.37 d vs 12.32 d,t=-2.441,P=0.018;24.33 d vs 36.29 d, Z=-2.624,P=0.009)。结论 儿童开颅术后应合理的留置脑脊液外引流管,留置期间保持引流管系统的封闭、尽早拔除引流管,可能有助于减少引流管相关颅内感染的发生。

Study on the correlation between cerebrospinal fluid drainage and intracranial infection after craniotomy in children

Objective To explore the correlation between external cerebrospinal fluid(CSF) drainage and intracranial infection after craniotomy in children.Methods The clinical data of 253 children who received craniotomy in pediatric neurosurgical ward of Beijing Tiantan Hospital, Capital Medical University between December 2018 and September 2019 were analyzed retrospectively. Results Among the 253 children cases, 113 cases had CSF external drainage after operation, the average retention time was 9 days (2-23 days). The incidence of postoperative intracranial infection was 30% (76/253) in all the 253 children and 54% (61/113) in those with external CSF drainage. Univariate analysis (χ²=55.702, P<0.001) and multivariate analysis (OR=8.045, 95% CI: 4.121-15.703, P<0.001) showed that indwelling external drainage tube was an independent risk factor for intracranial infection. Among 113 cases, 41 cases were treated with open external drainage system of CSF after operation. Statistics showed that the rate of intracranial infection in the open group was higher than that in the closed group (75.6% vs 41.6%, χ²=12.116,P<0.001). The incidence of intracranial infection was directly proportional to the drainage time. On the fifth day, the infection rate and the accumulated infection rate were the lowest, 25% and 27%, respectively. The time for antibiotics use and postoperative hospital stay of the patients with intracranial infection who received CSF drainage within one week were shorter than those longer than one week (9.37 d vs 12.32 d, t=-2.441, P=0.018; 24.33 d vs 36.29 d, Z=-2.624, P=0.009). Conclusion Reasonable retention of external CSF drainage after craniotomy in children, keeping the drainage tube system closed and pulling out the drainage tube as early as possible may help to reduce the incidence of intracranial infection related to drainage.