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首页 影响颅脑外伤术后颅内感染的危险因素分析

影响颅脑外伤术后颅内感染的危险因素分析.pdf

影响颅脑外伤术后颅内感染的危险因素分析

whsst1104
2013-04-20 0人阅读 举报 0 0 0 暂无简介

简介:本文档为《影响颅脑外伤术后颅内感染的危险因素分析pdf》,可适用于人文社科领域

��史华神经辱燮多冬志���年�月兰互卷第�期�������������,����!,����,���·临床研究·影响颅脑外伤术后颅内感染的危险因素分析胡深杨佳勇魏学忠傅炜听岳亚丁【摘要】目的探讨影响颅脑外伤开颅术后颅内感染的危险因素。方法采用回顾性研究比较分析了���例颅脑损伤术后出现颅内感染与未出现颅内感染组间的差异因素。结果非感染���例,颅内感染���例�������。感染类型有无菌性脑膜炎、细菌性脑膜炎、脑室炎及脑室积脓、脑脓肿、硬膜下腔积脓、术区皮下或�和�骨瓣下化脓或合并骨髓炎、切口感染。细菌检出率占感染的�����。颅脑外伤术后感染与高温季节、高龄、重度以上损伤、短期内两次以上手术、连续两侧开颅术、长时间�����手术、显微外科手术、颅底与后颅凹手术、脑室外引流、皮下或硬膜外积液以及急诊手术等因素相关�凡�����。结论对具有上述危险因素的易感患者应给予更密切的关注和预防性的处理。【关键词】颅脑损伤�术后感染�危险因素【中图分类号】�������【文献标识码��【文章编号�����一��!����印�礴��一��������������������������������������������������������������������������������������������,��������,�〕���,�����、��峪�����一���,�����一��峪���尸��������������哪哪������钻�心��,�������������������’����户��以,���朋�����仍�,�����【��������】�������������������。�������������������������������������������������������������������������������������������������������������������������������������一��������������������������������������������!�����!���������������������������������������������������������!�����一���������������������������������������������,������������������������!∀#�∃��∋�(�)#∋∗��#�∃#(#,bacterialmeningitis,cerebralventrielitisandventriealPusaceumulation,cerebralabscess,subduralPusaeeumulation,subeutaneousorandsubskullflapPusaeeumulationorosteomyelitis,andineisioninfeetionsTherateofbacterialdeteetionwas万PostoPerativeinfeetionsfollowingbraininjtlrysurgerywererelatedtohotterweather,advaneedageofPatients,severityoftraumatiestate,multiPleoPerationsinshorttime,sueeessiveordouble一lateralcraniotomies,long一time(>sh)oPeration,microsurgery,oPerationonskullbaseorPostfossa,eerebralventrieledraining,subeutaneousorePiduralh川roPs,andemergeneyoPeration(六,)ConelusionItshouldbegivenmoreattentionandProP场lactietreatmentsforthebraininjurywithinfeetiveriskfactorsmentionedabove【KeywordsCraniocerebralinju叮postoperativeinfection:RiskfaetorBesideseerebraledemaandinlraeranialhematoma,intracranialinfeetionconsideredasoneofthreeriskfaetorsafteroPerationsoferaniocerebralinjury,itsfeatureseonsistingofhighmothidity,insidiousonset,confusedmanifestations,limitationindrugsehoice,eomPlieationindrugadministrationandominousPrognosishithisstudy,weanalyzecliniealdatainretrosPecttofindoutriskfaetorsrelevanttothesPecifieinfeetionsforthePurposeofcliniealProPhylaxesandtfCat】ClltSClinicaldstaandmethods作者单位:广东省深圳市第六人民医院脑血管病科(胡深、杨佳勇)沈阳,沈阳军区总医院(魏学忠、傅炜听)广东省深圳市新宇龙信息科技有限公司(岳亚丁)CliniealdataTotally,thecliniealdataofPatients(male,female,agedl一years,averageage:)undergoingeraniaotomyaftereranioeerebralinjurywereeolleetedfromNovembertoNovemberandfromJanu脚toJanua理Ofall,(,)casesdeveloPedintointraeranialinfeetionsThestandardsfordataeolleetionwereregulatedtomeetthefollowingindieations:first一hosPitalization,mediumorsevereelosedinjuryoroPenedinjury,routinebacteriologiealexaminationsofCSFordrainingliquidoreffosionforatleasttimesTheclinicaldiagnosiseriteriafor‘f,华神经医学杂志年月第卷第期ChinJNeuromed,May,vots,NononbacterialmeningitiswerebasedonBaltasetaloPinions:WBC>mmandGlucose<mgdLinCSFI’TheeountsofrealWBCeheekedinbloodyCSFwerediseountedbyratioof场『BCRBC=l“StandardsforexelusionincludedPatientswithouteraniotomyorcomPlieatedwithseverenon一CNSinjuriesThedataeolleetioneoveredsurgeon,ageandsexofthePatients,seasonofinjury,intervalsfrominjurytoeraniotomy,traumatyPes,GCSseore,datesandtyPesofsurgery(emergencyoPeration,multiPleoPerations,double一lateraleraniotomies,over一一hour一IongoPeration,mierosurgery,oPerationonskullbaseorPostfossa,dura一oPenedoPeration,eerebralventrieledrainingandlumberPuneture),tyPesofintraeranialinfections,bloodroutineexamination,bodytemPerature,intra一andPost一oPerativeeomPlieationsThesefaetorswererelatedtoelinicalouteome(exeellent,good,PooranddeadbyGOS)AlldeathswitlinthreemonthsaftersurgerywereaeeountedassurgiealdeathsSurgiealtreatmentChiefoPeratorshaves一yearexPerieneeofneurosurgeryThird一generationCePha一listantibioticsbeforeoPerationwasearlyusedbyvenousinfusionasusualProPhylaetiemeasuresCarefuldebridemntwasPerformedPertinenttothecraniotomyduringoPerationastorestoretheintegrityofduramatter,leavenodead一sPaeeandsealofoPenedParanasalsinusesBesidesofroutineintravenousorneeessaryintrathecaladillinistrationofantibioties,PostoPerativesPeeialtreatmentsineludeddrainingCSFbyintrathecalintubationtoPromotethehealofleakage,forPatientswithCSFotorrheaorrhillorrheaorincisionleakagesforoveroneweek,andconduetedimmediatedebridementforthosePatientswithsubeutaneousandsubskullflaPinfeetionsorosteomyelitisStatistiealanalysesDatawereanalyzedwithstatisticalsoftwareSPSSThePearsonehi一squaretestwasPerformedfordeteetingriskfaetorsrelatedtothePostoPerativeinfeetionbaeterialmeningitis,()eerebralventriclitiseombinedwithventrielePusaeeumulation,()eerebralabseess,()subduralPusaeeumulation,()subeutaneousorandsubskullflaPPusaccumulationorosteomyelitis()ineisioninfeetionsDeteetionrateofbaeteriainCSFordrainingliquidorwoundexudationwas(eases)inpostoperatiVeinfectionsMostbacteriafound()weregram一negativebacilli(Enterobaeillusgasoformans,verdigrisPseudomonas,nitrate一negativebaeillus,Baeilluseloaeae)andgram一Positiveeoeei(staPhyloeoceusandePidermidis)wererare()Althoughthematerialsanddatawereobtainedfromtwodifferentregions,theformationofbaeteriaresPonsiblefornosoeomialinfeetionseemedsimilar,insPiteofalittlediffereneeinratiooftheforlllationsTheinfeetionsinPatientsremaineduneontrolledbeforetheirdeathfromintraeranialinfections,frombacterialmeningitis,frombaeterialmeningitiseombinedwithventrielePusaceumulation,fromeerebralabscessandfromehroniePersistingnonbaeterialmeningitisThefactorsrelevanttotheinfeetionslikeage,season,PreoPerativetraumaticstate,injurytyl〕es,oPerationtyPesandothersurgiealeonditionsareshowninTableandTableThehighinfectionratewasalsorelatedtohighmorbidityofcontreeouPinjuriesinoldPatientsaged一(P<ol)TheineideneeofinfeetionalsohigherinthePatientswithsevereinjuryanddeePeoma(P<ol)Althoughthedataswereeolleetedfromdifferentregions,itwassimilarthattherateofinfeetioninhotterseasonwashigherthanthatineold(称)Fire一armandoPeninjuriesweresignifieantlyrelatedtobacterialmeningitis(P<O)ItwasnotmoreinfeetionoecuringforPatientswithkeePingduraelosureinoPerationandoPeratingnotonskullbaseDiseussionResultSandotltCme()outofeasesdevelopedintoinfeetionsindueedbyeraniotomyfromeraniocerebralinjury,withtheinfeetivetyPesincludingcases()ofnonbaeterialmeningitisand()ItwasrePortedthattheineideneeofinfeetionafterbraininju叮operationwasabout一,“,whiehconsideredreasonableinclinicalPractieebasedonBaltasdiagnosiseriteria‘However,arelativelylowineideneeofinfeetionswasseeninourstudy,whiehmayarousefromthechangesintheaPProaehesforeffeetiveantibioticadministration,thedifferenttraumatieformationsandthePertinentProPhylaetictreatmentsduringoPerationInaddition,CSFeireulationin中华神经医学杂志年月第卷第期ChinJNeuromed,Mav,Vols,NoTabPerioPerativefaetorstoPostOPerativeinfeetionsinPatieniswithbraininjury()Non·infeetiongrouPVarlablegrollP(eases)(eases)丫Age(years):l~一~闷~~~~()(,)()(乡)(石)(刀)()()()()(,)(乡)()(沸)(滩)(刀)(,)()夕<Traulllaquarter:first(Jan一Mareh)seeond(APril一June)third(Jul梦SePt)fourt卜(oet产Dee〕G〔!seores(mean):~卜~~Injtrymode:elosedinjurymidi明severe(mostsevere)。penInjuryfire一anninjuryehronieSDHTimefrominjuryto叩:lesslhanh尸礴shSDH:subdurahemottomaoP:oPeration()(石)()()<刀()(石)()(l、)<()(、)()(、)()()()()()l()<刀(,)()()()l,TabSllrgiealfaetorstoPostoPerativeinfeetioninPatientswithbraininjury()VariableNon一infectiongrouPOngrouP犷EmergeneyoP工<h)BilateraloPMultiPleoP·功ng一timeoP(>sh)Mierosurgery即习nskullbasePostfossaOP乃nothersitesDuraOpelloPNon一dura~叩en叩·Extra、entricaldrainingPostoPerativeeomPlieationsSubeulaneousorandePiduralhydroPs〕hers(hemorrhage,infarction,hydroeePhalus)P<乃,:non一infeetivegro叩oP:oPeration(eases)()(刀)()()()(刀)()(石)()(月)(eases)()()()()()()(乡)()()(),,名名一<刀<刃j。()(乃)()(·)石中华神经医学杂志年月第卷第期ChinJNeuromed,M盯,Vols,NoCNSnoteffeetiveasgeneralbloodeirculationintheasPeetoflimitation,resista刀ce,inactivationandmetabolietransformationagainstinfeetivesoureesfromitsbeingineidentallyoPeneduPOntheotherhand,BBBinCNSdetainsgeneralantlbiotiesthatithardtofunetion()Infeetivesource:Theinfectivesourcesarenotdefiniteonmanyeonditionsl〕Thebaeteriologiealtestinourstu即hasshownmajorityofinfeetivediseaseseameouttobenonbacterialmeningitis,andeveninthefewPositiveeases,enteriebaeilliweretheehieforganismsofbaeterialinfeetionsinwhichGram一ositivebacillidominatedEven,thereexistedtwokindsofeonditionsforthenegativeresultofbaeteriologiealexarnination:firstwastruenonbaeterialandseeondwasPseudo一negativeresultfromroutineadministrationofantibiotiesaneroperationaswellassomeotherreasonsfromlaboratoryForexamPle,anaerobeeulturewasnotlakenasroutineexalnination()Modeofinfeetion:NonbaeterialmeningitiswasPrineiPallyrelatedtothealterationofsPeeialPhysiologieenviron们nentinsubaraehnoidsPaeeduetooperationBaeterialmeningitismainlyrelatedtofaetorssuehastraurnatietyPes,environment,laxsterilizationoftheapParatusoroPerators,long一timeoPeration,CSFleakage,subeutaneousandePiduralhydrPsThedeteetedbaeteriainbacteriologiealexaminationsmainlybelongtothoseProdueingnosoeomialinfeetionsandPeri一oPerativeriskfaetorsdoallowthemmorePossiblytoinvadeThesimilarformationsofbaeteriaindueingnosocomialinfeetionsindifferenthosPitalsmayhavesomethingtodowiththesimilaradministrationofantibiotiesastoProdueesimilardrug一fastbaeteria〕Therefore,iteffeetivetoPreveninonbaeterialmeningitisbyearefullyProteetingoperativeregion,douehingtheoPeratedfieldrePeatedlyandsealingduraineisionswithgiuebeforeelosingeraniumOntheotherhand,in

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