神经外科术后颅内感染的影响因素及风险预测分析被引量：39

Influencing factors of intracranial infection and risk prediction analysis after neurosurgical operation

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摘要目的调查分析神经外科手术患者术后颅内感染的发生率及其影响因素，并进行颅内感染风险的预测分析。方法纳入2012年8月至10月首都医科大学附属北京天坛医院神经外科术后患者2058例，按切口类型术前0．5—2．0h预防性应用抗生素（应用时限I类切口≤24h，II类切口≤48h）。多因素Logistic回归模型分析影响术后颅内感染的因素并建立感染预测评分量表。受试者工作特征曲线（ROC）分析预测感染的阈值。结果2058例患者中，216例（10．5％）发生颅内感染，细菌培养阳性率为13．4％（29／216）。I类和Ⅱ类切口术后颅内感染的发生率分别为10．1％（115／1137）和11．0％（101／921）。多因素Logistic回归分析显示，低龄、手术时间延长、后颅窝和脑室内手术是术后颅内感染的独立危险因素。其中与17～40岁患者比较，40～60岁和≥60岁患者术后发生颅内感染的OR值（95％c1）分别为0．546（0．401～0．745）、0．277（0．153—0．499）；与鞍区比较，幕上、脊髓／非肿瘤、脑干／小脑脑桥角区／小脑、脑室术后发生颅内感染的OR值（95％CI）分别为3．014（1．329～6．838）、1．977（0．855～4．571）、4．585（1．971—10．666）、8．410（2．924—24．195），与手术时间〈4h比较，4-〈7h和≥7h患者发生颅内感染的OR值（95％C1）分别为4．555（2．280～9．100）、8．939（4．292～18．615），均P〈0．01。ROC曲线预测I类切口术后颅内感染的综合评分阈值为-2．2分，其中低危组（〈-2．2分）颅内感染的发生率为4．4％（30／685），高危组（≥-2．2）为18．8％（85／452）；Ⅱ类切口颅内感染的综合评分阈值为-1．9，低危组（〈-1．9）和高危组（≥-1．9）术后颅内感染的发生率为3．1％（18／588）、24．9％（83／333）。结论年龄、手术部位和手术用时是术后颅内感染的独立相关因素，由此建立的危险因素评分量表可预测术后颅内感染的风险，为差异化预防应用抗生素提供了依据。 Objectives To analyze the incidence, risk factors of intracranial infection after neurosurgical operation and to propose a prediction score scale based on these risk factors. Methods New prophylactic strategy of antibiotics （ timing ： O. 5 - 2 h ahead of neurosurgical procedures ; duration ： 24 hours for type I incision and 48 hours for type I1 incision） was used in 2012, and 2 058 patients from August to October were chosen for analysis. Based on the independent risk factors identified by logistic regression, a score scale was proposed to stratify patients into high-risk or low-risk group for postoperative intracranial infection. Results The incidence of intracranial infection for type I and type ]I incision was 10.1% （115/1 137） and 11.0% （101/921）, respectively. Logistic regression revealed that younger patients, longer operative duration, and lesion in the posterior fossa or the ventricles were independent risk factors for postoperative intracranial infection. Compared with the patients aged 17 -40, the ORs （95% CI） of intraeranial infection in patients aged 40 - 60 and 〉160 were 0. 546 （0. 401 - 0. 745 ） and 0. 277 （0. 153 - 0.499） , respectively. Compared with the lesions in the sellar region, the ORs （95% CI） of intracranial infection for lesion in the supratentorial region, spinal canal, brainstem/cerebellopontine angle/cerebellum, and the ventricle were 3. 014 （1. 329 - 6. 838 ）, 1. 977 （0.855-4.571）, 4. 585 （1.971 - 10.666）, and 8. 410 （2.924 - 24. 195）, respectively. Compared with operative duration 〈 4 h, the ORs （95% CI） of intracranial infection for 4 -7 h and 〉~ 7 h were 4. 555 （2. 280 - 9. 100） and 8. 939 （4. 292 - 18. 615） , respectively. On ROC curve, the cutoff score to predict intracranial infection for type [ and type 11 incision was - 2.2 and - 1.9, respectively. For type I incision, the frequencies of intracranial infection in low-risk （〈 - 2.2） and high-risk （〉I -2.2） groups were 4.4% （30/685） and 18.8% （85/452） , respctively. For type II incision, the frequencies of intracranial infection in low-risk （〈 - 1.9） and high-risk （ 1〉 - 1.9） groups were 3. 1% （ 18/588 ） and 24. 9% （83/333） , respectively. Conclusions Younger age, longer operative duration and lesions in the posterior fossa or the ventricle were independent risk factors for postoperative intracranial infection. The prediction score scale could be effectively used to stratify patients into high-risk or low-risk group for postoperative intracranial infection, which provided the basis for individualized prophylactic strategies of antibiotics.

作者任晓辉张扬高之宪季楠张俊廷张力伟

机构地区首都医科大学附属北京天坛医院神经外科

出处《中华神经外科杂志》 CSCD 北大核心 2015年第10期992-996,共5页 Chinese Journal of Neurosurgery

基金国家科技支撑计划（2014BA104801）

关键词中枢神经系统细菌感染神经外科手术危险因素预测 Central nervous system bacterial infections Neurosurgical procedures Riskfactors Prediction

分类号 R651 [医药卫生—外科学]

作者简介通信作者：张力伟，zhanglw@bjtth．com

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