脑动脉瘤术后腰大池置管引流患者颅内感染及影响因素

Occurrence of intracranial infection and its influencing factors in patients with lumbar cistern catheter drainage after cerebral aneurysm surgery

摘要:

目的 了解Hunt-Hess高分级颅内动脉瘤破裂术后腰大池置管引流患者颅内感染情况及其影响因素。方法 收集某院2017年3月-2018年5月脑血管病诊疗中心收治的Hunt-Hess高分级颅内动脉瘤破裂手术患者的临床资料，分析患者社会人口学情况、病情、治疗过程、术后颅内感染情况及其危险因素。结果 共有72例Hunt-Hess高分级颅内动脉瘤破裂手术后腰大池置管引流患者，发生颅内感染30例，感染率为41.67%。单因素分析结果显示，不同年龄、入院mRS评分、术前抗菌药物使用情况、脑脊液漏情况、引流管污染情况的患者颅内感染率比较，差异均有统计学意义（均P<0.05）。logistic回归分析结果显示，影响其感染的主要因素为：有脑脊液漏（OR=3.68）、术前未预防性使用抗菌药物（OR=3.18）、引流管污染（OR=2.82）、入院mRS评分≥ 4分（OR=2.51）、年龄≥ 61岁（OR=1.06）。结论 Hunt-Hess高分级颅内动脉瘤破裂术后腰大池置管引流患者颅内感染率较高，控制脑脊液漏、预防性使用抗菌药物、引流管使用时加强无菌操作均可有效减少术后腰大池置管引流患者颅内感染的发生。

Abstract:

Objective To investigate intracranial infection in patients with lumbar cistern catheter drainage after surgery for Hunt-Hess high-grade ruptured cerebral aneurysm, and analyze the influencing factors. Methods Clinical data of patients who underwent surgery for Hunt-Hess high-grade ruptured cerebral aneurysm in the cerebrovascular disease diagnosis and treatment center of a hospital between March 2017 and May 2018 were collected. The social demography, disease condition, treatment process, post-operative intracranial infection, and risk factors were analyzed. Results There were 72 patients with lumbar cistern catheter drainage after surgery for Hunt-Hess high-grade ruptured cerebral aneurysm, 30 (41.67%) had intracranial infection. Univariate analysis showed that there were significant differences in intracranial infection rates among patients of different ages, mRS score at admission, preoperative use of antimicrobial agents, cerebrospinal fluid leakage and drainage tube contamination (all P<0.05). Logistic regression analysis showed that the main factors affecting the infection were cerebrospinal fluid leakage (OR=3.68), without preoperative use of antimicrobial agents (OR=3.18), drainage tube contamination (OR=2.82), mRS score ≥ 4 at admission (OR=2.51), and age ≥ 61 years (OR=1.06). Conclusion Intracranial infection rate in patients with lumbar cistern catheter drainage after surgery for Hunt-Hess high-grade ruptured cerebral aneurysm is high, control of cerebrospinal fluid leakage, preventive use of antimicrobial agents, strengthening aseptic operation when using drainage tube can effectively reduce the incidence of intracranial infection in patients with lumbar cistern catheter drainage after surgery.