开颅术后神经系统感染的危险因素及临床干预

目的探讨开颅术后神经系统感染的危险因素,并提出临床干预措施,以降低神经系统感染的发生率。方法选取2015-01—2016-11在平煤神马医疗集团总医院行开颅手术的患者234例,回顾性分析所有患者的临床资料,按照术后是否发生神经系统感染分为实验组41例和对照组193例,分析神经系统感染的危险因素及临床干预措施。结果通过对2组潜在危险因素对比发现,神经系统感染的发生与60岁老年人、手术时间≥4h、放置引流管、术前未预防性应用抗生素、≥2次手术、术中发生脑脊液漏及实施脑室体外引流术有关,差异有统计学意义(P0.05)。通过多因素分析发现,手术时间、留置引流管、术中脑脊液漏、脑室体外引流术是开颅术后神经系统感染的独立危险因素,术前预防性应用抗生素是保护因素,差异有统计学意义(P0.05)。结论开颅术后神经系统感染的危险因素主要有年龄60岁、手术时间≥4h、放置引流管、手术次数≥2次、术前未预防性应用抗生素、术中发生脑脊液漏及实施脑室体外引流术。通过术前加强营养、增加患者身体抵抗力、预防性应用抗生素、术中严格执行无菌原则、术后严密监测病情变化等降低开颅术后神经系统感染的发生率。一旦发生神经系统感染可进行控制颅内感染、心理护理、保持大便通畅及五官护理等降低神经系统感染的病死率。

Risk factors and clinical intervention of neurological infection after craniotomy

Objective To explore the risk factors of neurological infection after craniotomy,and to propose clinical intervention measures to reduce the incidence of nervous system infection.Methods A total of 234 patients underwent craniotomy from January 2015 to November 2016 in Pingmei Shenma Medical Group General Hospital were retrospectively analyzed.The clinical data of all patients were analyzed retrospectively.The patients were divided into experimental group (41 cases) and control group (193 cases),and the risk factors of neurological infection and clinical intervention measures were analyzed.Results The occurrence of nervous system infection was significantly related to the elderly over 60 years old,the operation time ≥4 hours,drainage tube application and the use of preventive antibiotics (P ＜ 0.05).By using the multivariate analysis,operation time,drainage tube indwelling,intraoperative cerebrospinal fluid leakage and intraventricular drainage were the independent risk factors for neurological infection after craniotomy,and the preoperative preventive application of antimicrobial agents was the protective factor.Conclusion The risk factors of neurological infection after craniotomy are over 60 years old,more than 4 hours operation,the drainage tube application,twice or more operations,absence of antibiotics before operation,intraoperative cerebrospinal fluid leakage and intraventricular drainage.Strengthening the nutrition before surgery can increase the patient's immunity.Preventive usage of antimicrobial drugs,strict implementation of the principle of sterility and monitoring of changes of condition after surgery can reduce nervous system infection after craniotomy.In the event of neurological infection,controlling the intracranial infection,application of psychological care,keeping the bowls open and giving facial care can reduce the mortality rate of nervous system infection.