颅脑手术后并发脑膜炎危险因素分析

目的　探讨颅脑手术后并发脑膜炎的危险因素及预防措施。方法　回顾性分析 1994年 1月至2 0 0 2年 12月收治的 4 877例施行颅脑手术患者的临床资料。结果　术后并发脑膜炎 14 1例 (占 2 .89% ) ,其中无菌性脑膜炎 12 0例 ,细菌性脑膜炎 2 1例。术后脑脊液漏、刀口皮下积液及因急症再次手术者 ,脑膜炎的发生率分别为 35 .34%、2 4 .6 0 %及 15 .78% ,明显高于总病例脑膜炎发生率 (2 .89% ) ,P<0 .0 5 ;有颅脑手术史者术后脑膜炎发生率为 5 .10 % ,幕下手术后为 6 .4 0 % ;手术时间 4～ 8小时者为 4 .4 0 % ,8小时以上者为 7.0 9% ;术前使用糖皮质激素者为 4 .80 % ;术后未用激素者细菌性脑膜炎发生率为 0 .1% ,应用激素者发生率为 0 .5 2 %。结论　术后脑脊液漏、刀口皮下积液及因急症再次手术是颅脑手术后并发脑膜炎的危险因素 ,手术后应用糖皮质激素是并发细菌性脑膜炎的危险因素

Analysis of risk factors for the incidence of meningitis after craniotomy

Objective To investigate the risk factors and the preventive measures of meningitis after craniotomy Methods Data of 4877 patients with neurosurgical procedures in our department were retrospectively collected from January, 1994 to December, 2002 Results Meningitis were occurred in 141 patients(2 89%)and 120 patients of them were aseptic and others were becterial meningitis Incidences of meningitis in patients with postoperative CSF leakage, subsequent accumulative liquid under scalp flap and those of emergency subsequent surgery after craniotomy were 35 34%, 24 60% and 15 78% respectively, which were significantly higher than the mean incidencice of the 141 patients(P<0 05) Incidence of meningitis in patients with previous craniotomy were 5 10% ,those of the operation time lasted 4~8 hours was 4 40 % and those of above 8 hours was 7 09% Incidence of meningitis in patients with a preoperative glucocorticoid therapy was 4 80% Incidence of bacterial meningitis in patients with a postoperative glucocorticoid therapy was 0 52% and those without glucocorticoid therapy was 0 1% Conclusion Independent risk factors for meningitis after neurosurgical procedures were postoperative CSF leakage, subsequent accumulative liquid under local scalp flap and early subsequent operation Glucocorticoid therapy postoperatively is the risk factors for bacterial meningitis