后颅窝手术后并发颅内感染危险因素分析及防治措施

目的 探讨后颅窝手术后并发颅内感染的相关危险因素,为临床防治颅内感染提供依据.方法 搜集2006年1月-2011年12月在我院神经外科接受后颅窝开颅手术后并发颅内感染的12例临床资料进行回顾分析.结果 ①单因素条件logistic回归分析结果:手术持续时间长、术后脑脊液漏、术中开放乳突气房、术中使用人工硬膜、使用吸收性明胶海绵、脑室外引流是后颅窝手术并发颅内感染的危险因素;②多因素条件logistic回归分析结果:术中开放乳突气房、术中使用人工硬膜、术后脑脊液漏是并发颅内感染的独立危险因素;③12例经综合治疗后11例痊愈,1例死亡.结论 对于后颅窝手术除非不得已不要打开乳突、不使用人工硬膜(取自身筋膜代替)、加强切口管理、减少脑脊液漏是降低术后颅内感染的关键.一旦发生颅内感染,应采取综合治疗措施.

Analysis of Risk Factors and Prevention of Intracranial Infection in Patients after Posterior Fossa Craniotomy

Objective To investigate the risk factors of intracranial infection after posterior fossa craniotomy in order to provide a basis for the prevention and treatment of intracranial infection. Methods Clinical data of 12 patients with intracranial infection after posterior fossa craniotomy in the neurosurgery of our hospital during January 2006 and December 2011were retrospectively analyzed. Results ①Single factor conditional logistic regression analysis showed that the operation lasting for a long time, postoperative leakage of cerebrospinal fluid, intraoperative opening mastoid air room, intraoperative use of artificial dura mater and gelatin sponge, ventricular drainage were the risk factors of infection intracranial infection after the posterior fossa surgery; ②Multivariable analysis showed that intraoprative opening mastoid air room, intraoperative use of artificial dura mater and postoprative eerebrospinal fluid leakage were the independent risk factors for intracranial infection; ③The outcome of 12 patients： 11 patients were cured and 1 died. Conclusion For the posterior fossa surgery, unless necessary, dont open the mastoid process or use artificial dura mater （take their own instead of fascia） , augment the incision management and reduce the cerebrospinal fluid leakage reduction, which are the key of reducing postoperative intracranial infection. Comprehensive treatment measures should be taken in the event of intracranial infection.