TBI后颅内感染的发生情况和危险因素

目的探讨颅脑损伤(TBI)术后颅内感染的发生率及发生颅内感染的危险因素。方法 2012年1月—2015年12月川北医学院附属医院神经外科收治1 349例TBI患者,道路交通伤542例,高处跌落332例,重物砸伤291例,其他原因184例。其中47例在术后出现颅内感染(感染组),男性31例,女性16例;年龄21~65岁,平均42.0岁;按照年龄、性别进行1∶2匹配的原则选取94例术后未发生颅内感染的TBI患者作为对照组,男性58例,女性36例;年龄20~65岁,平均40.7岁。分析TBI患者发生颅内感染的危险因素。结果 TBI患者手术后并发颅内感染主要与开放性创伤、受伤至手术时间、脑室外引流时间、术后白蛋白水平有关(OR=1.629、95%CI:1.284~4.429,OR=1.531、95%CI:1.227~4.302,OR=1.776、95%CI:1.363~5.728,OR=0.601、95%CI:0.275~0.930,P0.05),与患者入院时的GCS评分关系不显著(OR=0.581、95%CI:0.241~0.836,P0.05)。结论 TBI患者术后容易并发颅内感染,开放性创伤、受伤至手术时间、脑室外引流时间是TBI患者术后并发颅内感染的危险因素,术后白蛋白水平是患者并发颅内感染的保护性因素。

Occurrence and risk factors of intracranial infection after traumatic brain injury

Objective To investigate the incidence and risk factors of postoperative intracranial infection in patients with traumatic brain injury(TBI).Methods Totally 1349 TBI neurosurgical patients were treated in our hospital from Jan.2012 to Dec.2015,including 542 cases of traffic accident injury,332 cases of high-falling injury, 291 cases of crushing injury and 184 cases of other causes.Among them,47 cases who had postoperative intracranial infection were taken as infection group(there were 31 males and 16 females,with an average age of 42.0 years), and 94 cases who did not have intracranial infection were taken as control group(there were 58 males and 36 fe-males,with an average age of 40.7 years).The risk factors of intracranial infection for TBI patients were analyzed. Results The occurrence of intracranial infection in TBI patients after major surgery were related with open wounds, time from injury to operation,ventricular drainage time and postoperative albumin level(OR=1.629,95%CI:1.284~4.429;OR=1.531,95%CI:1.227~4.302;OR=1.776,95%CI:1.363~5.728;OR=0.601,95%CI:0.275~0.930,P<0.05),and was not significantly related with GCS score at admission(OR=0.581,95%CI:0.241~0.836,P>0.05).Conclusion TBI patients are prone to occur intracranial infections.Open wounds,time from injury to operation and ventricular drainage time are risk factors of intracranial infection for TBI patients,and postop-erative albumin level is a protective factor for intracranial infection.