3D打印辅助微创治疗高血压脑出血颅内感染的影响因素及对策
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1.滨州医学院附属医院神经外科, 山东 滨州 256603;2.滨州医学院附属医院代谢与神经精神疾病研究所, 山东 滨州 256603;3.滨州医学院护理学院, 山东 烟台 264003

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许红梅  E-mail: hmx58@163.com

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山东省医药卫生科技发展计划基金资助项目(2019WS330)


Influencing factors and countermeasures for intracranial infection after three-dimensional printing-assisted minimally invasive treatment for hypertensive intracerebral hemorrhage
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1.Department of Neurosurgery, Binzhou Medical University Hospital, Binzhou 256603, China;2.Institute for Metabolic and Neuropsychiatric Disorders, Binzhou Medical University Hospital, Binzhou 256603, China;3.School of Nursing, Binzhou Medical University, Yantai 264003, China

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    摘要:

    目的 分析3D打印辅助微创治疗高血压脑出血(HICH)术后颅内感染的影响因素,并探讨相应的预防对策,为术后颅内感染防控措施的制定提供依据。 方法 回顾性分析2015年10月—2018年12月某综合三级甲等医院神经外科行3D打印辅助微创治疗HICH患者的临床资料(n=324),依据是否发生颅内感染分为感染组与非感染组,比较两组患者的一般资料、手术治疗过程等差异。 结果 324例3D打印辅助微创治疗HICH患者,发生颅内感染32例,感染率为9.87%。颅内感染患者送检标本检出病原菌19株,其中革兰阴性菌9株(47.37%),革兰阳性菌8株(42.10%),真菌2株(10.53%)。3D打印辅助微创治疗HICH患者单因素分析结果显示,吸烟史、颅内出血量、术前备皮距手术时间、手术地点、手术持续时间、术后溶凝治疗次数、引流管留置时间、预防性使用抗菌药物8项因素比较,差异具有统计学意义(均P < 0.05);多因素logistic回归分析结果显示,预防性应用抗菌药物为预防颅内感染的保护性因素,而颅内出血量、术前备皮距手术时间、手术持续时间,引流管留置时间是发生颅内感染的独立危险因素。 结论 3D打印辅助微创治疗HICH患者术后发生颅内感染是多种因素共同作用的结果,在围手术期重要环节采取有效的防控措施,是预防颅内感染的关键。

    Abstract:

    Objective To analyze the influencing factors for post-operative intracranial infection after three-dimensional printing-assisted minimally invasive(3DP-MI) treatment for hypertensive intracerebral hemorrhage (HICH), explore the corresponding preventive measures, so as to provide basis for the formulation of prevention and control measures of post-operative intracranial infection. Methods Clinical data of 324 patients who underwent 3DP-MI treatment in neurosurgery department of a tertiary hospital from October 2015 to December 2018 were retrospectively analyzed, according to whether intracranial infection occurred, patients were divided into infection group and non-infection group, general information and surgical treatment course of two groups of patients were compared. Results Among 324 patients undergoing 3DP-MI treatment, 32 (9.87%) had intracranial infection. 19 strains of pathogens were isolated from specimens of patients with intracranial infection, including 9 strains (47.37%) of Gram-negative bacteria, 8 strains (42.10%) of Gram-positive bacteria, and 2 strains (10.53%) of fungi. Univariate analysis on HICH patients undergoing 3DP-MI treatment showed that differences in smoking history, intracranial hemorrhage volume, time from pre-operative skin preparation to operation, operation location, operation duration, times of post-operative thrombolytic therapy, indwelling time of drainage tube, and prophylactic use of antimicrobial agents were all significantly different (all P < 0.05); multivariate logistic regression analysis showed that prophylactic use of antimicrobial agents was the protective factor for the prevention of intracranial infection, while intracranial hemorrhage volume, time from pre-operative skin preparation to operation, operation duration, indwelling time of drainage tube were independent risk factors for intracranial infection. Conclusion Post-operative intracranial infection in HICH patients undergoing 3DP-MI treatment results from a variety of factors, the key to the prevention of intracranial infection is to take effective prevention and control measures during peri-operative period.

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吴敏,田晓玲,邱长云,等.3D打印辅助微创治疗高血压脑出血颅内感染的影响因素及对策[J]. 中国感染控制杂志,2021,(7):626-631. DOI:10.12138/j. issn.1671-9638.20218078.
Min WU, Xiao-ling TIAN, Chang-yun QIU, et al. Influencing factors and countermeasures for intracranial infection after three-dimensional printing-assisted minimally invasive treatment for hypertensive intracerebral hemorrhage[J]. Chin J Infect Control, 2021,(7):626-631. DOI:10.12138/j. issn.1671-9638.20218078.

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  • 收稿日期:2020-09-22
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  • 在线发布日期: 2021-08-04
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