摘要
目的探讨颅内肿瘤切除术后患者颅内感染病原菌特点及危险因素,为临床制定干预措施提供依据。方法收集济宁市第一人民医院2015年1月至2018年12月收治的638例行颅内肿瘤切除术的颅内肿瘤患者的临床资料,观察患者颅内感染发生情况,分析颅内肿瘤切除术后的感染病原菌分布、耐药性及危险因素。结果638例颅内肿瘤切除术患者发生颅内感染57例,感染率为8.93%。共分离病原菌16株,其中革兰阳性菌7株,占43.75%,以凝固酶阴性葡萄球菌为主,对青霉素类、头孢菌素类、氨基糖苷类、大环内酯类抗菌药物耐药率较高;革兰阴性球菌9株,占56.25%,以鲍曼不动杆菌为主,对青霉素类、头孢菌素类、β-内酰胺类、喹诺酮类抗菌药物耐药率较高。不同手术时间、术中出血量、引流时间,是否幕下手术、乳突气房或窦开放、脑脊液漏患者的术后颅内感染率差异有统计学意义(P<0.05);多因素Logistic回归分析结果显示,手术时间>4 h、幕下手术,引流管时间>24 h是颅内肿瘤切除术后发生颅内感染的独立危险因素。结论手术时间长、幕下手术、术后引流时间长是颅内肿瘤切除术后发生颅内感染的独立危险因素,应结合病原菌特点采取有效控制措施。
Objective To investigate pathogen characteristics and risk factors of intracranial infection in patients after intracranial tumor resection,so as to provide evidence for clinical intervention measures.Methods The clinical data of 638 patients with intracranical tumor undergoing intracranial tumor resection admitted to the department of Neurosurgery from January 2015 to Decemeber 2018 in Jining No.1 People s Hospital were collected.The incidence of intracanial infection was observed,the infection rate,distribution of pathogenic beacteria and influencing factors were analyzed.Results Totally 57 patients were infected among 638 patients with intracranial tumor resection,the nosocomial infection rate was 8.93%.A total of 16 pathogenic bacteria were isolated,of which 7 were gram-positive,accounting for 43.75%,mainly coagulase-negative staphylococcus,it had high resistance rate to antibiotics of penicillins,cephalosporins,aminoglycosides and macrolides.9 were gram-negative,accounting for 56.25%,mainly Acinetobacter baumannii,had high resistance rate to penicillins,cephalosporins,β-lactams,and quinolones.There were significant differences in intracranial infection rates among patients with different operation time,intraoperative bleeding volume,drainage time,whether subtentorial surgery,mastoid air chamber or sinus opening,cerebrospinal fluid leakage or not(P<0.05).The result of multivariate logistic regression analysis indicated that operation time>4 h,subtentorial surgery,drainage tube time>24 h,were the independent risk factors of intracranial infection after intracranial tumors resection.Conclusions Long operation time,under subtentorial surgery,and long-term drainage tube were independent risk factors for intracranial infection after intracranial tumor resection.Effective control measures should be taken according to the characteristics of pathogenic bacteria.
作者
李元叶
冯燕
孙春燕
LI Yuanye;FENG Yan;SUN Chunyan(Department of Infection Management,Jining NO.1 People s Hospital,Jining 272000,China)
出处
《中国肿瘤外科杂志》
CAS
2019年第6期420-423,共4页
Chinese Journal of Surgical Oncology
基金
山东省医药卫生科技发展计划(2016WS0156)
关键词
脑肿瘤
外科伤口感染
颅内肿瘤切除术
颅内感染
病原菌
危险因素
Brain neoplasms
Surgical wound infection
Intracranial tumor resection
Intracranial infection
Pathogen
Risk factors
