中华神经外科杂志
中華神經外科雜誌
중화신경외과잡지
Chinese Journal of Neurosurgery
2015年
10期
992-996
,共5页
任晓辉%张扬%高之宪%季楠%张俊廷%张力伟
任曉輝%張颺%高之憲%季楠%張俊廷%張力偉
임효휘%장양%고지헌%계남%장준정%장력위
中枢神经系统细菌感染%神经外科手术%危险因素%预测
中樞神經繫統細菌感染%神經外科手術%危險因素%預測
중추신경계통세균감염%신경외과수술%위험인소%예측
Central nervous system bacterial infections%Neurosurgical procedures%Risk factors%Prediction
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2 058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≤48 h).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 2 058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％ (115/1 137)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％CI)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％ CI)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.
目的 調查分析神經外科手術患者術後顱內感染的髮生率及其影響因素,併進行顱內感染風險的預測分析.方法 納入2012年8月至10月首都醫科大學附屬北京天罈醫院神經外科術後患者2 058例,按切口類型術前0.5～2.0h預防性應用抗生素(應用時限Ⅰ類切口≤24h,Ⅱ類切口≤48 h).多因素Logistic迴歸模型分析影響術後顱內感染的因素併建立感染預測評分量錶.受試者工作特徵麯線(ROC)分析預測感染的閾值.結果 2 058例患者中,216例(10.5％)髮生顱內感染,細菌培養暘性率為13.4％ (29/216).Ⅰ類和Ⅱ類切口術後顱內感染的髮生率分彆為10.1％ (115/1 137)和11.0％(101/921).多因素Logistic迴歸分析顯示,低齡、手術時間延長、後顱窩和腦室內手術是術後顱內感染的獨立危險因素.其中與17 ～40歲患者比較,40～60歲和≥60歲患者術後髮生顱內感染的OR值(95％CI)分彆為0.546 (0.401 ～0.745)、0.277 (0.153 ～0.499);與鞍區比較,幕上、脊髓/非腫瘤、腦榦/小腦腦橋角區/小腦、腦室術後髮生顱內感染的OR值(95％ CI)分彆為3.014(1.329 ～6.838)、1.977 (0.855 ～4.571)、4.585(1.971 ～ 10.666)、8.410 (2.924 ～24.195),與手術時間＜4h比較,4～＜7h和≥7h患者髮生顱內感染的OR值(95％ CI)分彆為4.555 (2.280 ～9.100)、8.939 (4.292 ～18.615),均P＜0.01.ROC麯線預測Ⅰ類切口術後顱內感染的綜閤評分閾值為-2.2分,其中低危組(＜-2.2分)顱內感染的髮生率為4.4％(30/685),高危組(≥-2.2)為18.8％ (85/452);Ⅱ類切口顱內感染的綜閤評分閾值為-1.9,低危組(＜-1.9)和高危組(≥-1.9)術後顱內感染的髮生率為3.1％(18/588)、24.9％(83/333).結論 年齡、手術部位和手術用時是術後顱內感染的獨立相關因素,由此建立的危險因素評分量錶可預測術後顱內感染的風險,為差異化預防應用抗生素提供瞭依據.
목적 조사분석신경외과수술환자술후로내감염적발생솔급기영향인소,병진행로내감염풍험적예측분석.방법 납입2012년8월지10월수도의과대학부속북경천단의원신경외과술후환자2 058례,안절구류형술전0.5～2.0h예방성응용항생소(응용시한Ⅰ류절구≤24h,Ⅱ류절구≤48 h).다인소Logistic회귀모형분석영향술후로내감염적인소병건립감염예측평분량표.수시자공작특정곡선(ROC)분석예측감염적역치.결과 2 058례환자중,216례(10.5％)발생로내감염,세균배양양성솔위13.4％ (29/216).Ⅰ류화Ⅱ류절구술후로내감염적발생솔분별위10.1％ (115/1 137)화11.0％(101/921).다인소Logistic회귀분석현시,저령、수술시간연장、후로와화뇌실내수술시술후로내감염적독립위험인소.기중여17 ～40세환자비교,40～60세화≥60세환자술후발생로내감염적OR치(95％CI)분별위0.546 (0.401 ～0.745)、0.277 (0.153 ～0.499);여안구비교,막상、척수/비종류、뇌간/소뇌뇌교각구/소뇌、뇌실술후발생로내감염적OR치(95％ CI)분별위3.014(1.329 ～6.838)、1.977 (0.855 ～4.571)、4.585(1.971 ～ 10.666)、8.410 (2.924 ～24.195),여수술시간＜4h비교,4～＜7h화≥7h환자발생로내감염적OR치(95％ CI)분별위4.555 (2.280 ～9.100)、8.939 (4.292 ～18.615),균P＜0.01.ROC곡선예측Ⅰ류절구술후로내감염적종합평분역치위-2.2분,기중저위조(＜-2.2분)로내감염적발생솔위4.4％(30/685),고위조(≥-2.2)위18.8％ (85/452);Ⅱ류절구로내감염적종합평분역치위-1.9,저위조(＜-1.9)화고위조(≥-1.9)술후로내감염적발생솔위3.1％(18/588)、24.9％(83/333).결론 년령、수술부위화수술용시시술후로내감염적독립상관인소,유차건립적위험인소평분량표가예측술후로내감염적풍험,위차이화예방응용항생소제공료의거.
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:0.5-2 h ahead of neurosurgical procedures;duration:24 hours for type Ⅰ incision and 48 hours for type Ⅱ 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 Ⅱ 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 intracranial infection in patients aged 40-60 and ≥60 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 Ⅰ and type Ⅱ 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 (≥-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 (≥-1.9)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.
