成人开颅术后并发细菌性脑膜炎的危险因素分析

目的 探讨开颅术后细菌性脑膜炎的发生率、常见病原菌及危险因素.方法 连续收集复旦大学附属华山医院2008年至少接受过一次颅脑手术病例的资料.纳入年龄≥18岁,且术后至少存活7d的病例,排除仅行脑脊髓液引流术、颅骨钻孔或颅骨整形术、与血管相关的介入手术、经鼻蝶手术及脊柱手术的患者.应用Logistic回归分析筛选开颅术后并发细菌性脑膜炎的危险因素.结果 共纳入691例患者,其中60例并发细菌性脑膜炎,感染率达8.68％.44份送检样本中,仅5份培养阳性,其中2株为鲍曼不动杆菌,其余分别为粪肠球菌、中间链球菌和肺炎克雷伯菌.糖尿病（OR =5.79,95％ CI：1.40 ～ 23.93,P=0.02）、格拉斯哥昏迷评分＜12分（OR=6.56,95％ CI：1.17～36.80,P =0.03）、脑室外引流（OR =4.31,95％ CI：1.57～11.82,P=0.01）和腰池持续引流（OR=22.82,95％ CI：10.31～50.52,P =0.00）是开颅术后脑膜炎发病的独立危险因素.脑室外引流超过7d,细菌性脑膜炎的发病风险增加11.82倍,而腰池持续引流超过10 d,细菌性脑膜炎的发病风险增加25.50倍.结论 细菌性脑膜炎是开颅术后常见的并发症,病原菌以革兰阴性杆菌为主.糖尿病、格拉斯哥昏迷评分、腰池持续引流及脑室外引流会增加术后细菌性脑膜炎发生的风险.

Risk factors for bacterial meningitis after major craniotomy in adults

Objective To investigate the incidence,bacterial pathogen and risk factors of bacterial meningitis after major craniotomy.Methods Clinical data of patients who underwent at least one craniotomy in Huashan Hospital Affiliated to Fudan University in 2008 were collected.All subjects were ≥ 18 years old,and survived at least 7 days after surgery.Patients with only cerebrospinal fluid drainage,burr holes,cranioplasty,vascular interventional surgery,transsphenoidal or spinal surgery were excluded.Risk factors for bacterial meningitis after major craniotomy were analyzed by Logistic regression.Results A total of 691 patients were enrolled,in 60 of whom （8.68%） bacterial meningitis was identified.Among 44 samples,5 were positive in culture with 2 of Acinetobacter baumannii,1 of Enterococcus faecalis,1 of Streptococcus intermedius and 1 of Klebsiella pneumonia.Diabetes （OR =5.79,95% CI：1.40-23.93,P =0.02）,Glasgow Coma Scale score 〈 12 （OR =6.56,95% CI：1.17-36.80,P =0.03）,external ventricular drainage （OR =4.31,95% CI：1.57-11.82,P =0.01）,and continuous lumbar cistern drainage （OR =22.82,95% CI：10.31-50.52,P =0.00） were independent risk factors for bacterial meningitis after major craniotomy.Patients with external ventricular drainage 〉 7 d were 11.82 times more likely to develop bacterial meningitis,and those with continuous lumbar cistern drainage 〉 10 d were 25.50 times more likely to develop bacterial meningitis.Conclusions Bacterial meningitis remains a common complication after major craniotomy,and most are induced by Gram-negative bacilli.Diabetes,Glasgow Coma Scale score,external ventricular drainage and continuous lumbar cistern drainage may increase its incidence .