颅内肿瘤手术患者医院感染危险因素分析

发布时间：2018-03-04 19:31

本文选题：颅内肿瘤　切入点：开颅术　出处：《广西医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:调查我院颅内肿瘤患者开颅术后医院感染发生情况,探讨颅内肿瘤开颅手术患者医院感染的危险因素及其防治措施。方法:在参考国内外相关文献资料的基础上,以广西医科大学附属肿瘤医院2014年1月至2016年6月期间行开颅手术颅内肿瘤患者为研究对象,对其临床资料进行回顾性调查,共收集病例288例,对医院感染发生率、感染部位、病原菌分布以及医院感染危险因素进行单因素和多因素Logistic回归分析。结果:1、2014年1月至2016年6月共调查颅内肿瘤手术患者288例,其中男性患者136例(占47.22%),女性患者152例(占52.78%),手术患者中最小年龄6岁,最大81岁,平均年龄45.70±15.49岁。2、调查的288例患者中有41例发生医院感染,感染率为14.24%;易感部位分布分别为:肺部感染27例(9.38%),颅内感染7例(2.43%),泌尿系感染3例(1.04%),血液感染2例(0.69%),切口感染2例(0.69%)。3、41例医院感染患者的痰液、脑脊液、切口分泌物、血液、尿液中,共检测出病原菌17株,其中革兰阴性菌7株,占41.18%;革兰阳性菌5株,占29.41%;真菌5株,占29.41%。其中白色念珠菌居首位,其次分别为金黄色葡萄球菌、铜绿假单胞菌、产ESBL大肠埃希菌。4、单因素分析结果显示:颅内肿瘤术后患者医院感染发生率在手术部位、手术时间、留置引流管、术中输血、手术次数、术后GCS评分方面差异有统计学意义(P0.05);而在性别、年龄、术前血糖、术后白蛋白、术后应用糖皮质激素、手术季节方面差异无统计学意义(P〉0.05)。手术部位、手术时间、留置引流管、术中输血、手术次数、术后GCS评分是颅内肿瘤患者术后医院感染的危险因素。多因素logistic回归分析显示幕下手术、留置引流管时间大于2天、术中输血、多次手术、术后GCS评分低是颅内肿瘤开颅术后患者医院感染的独立危险因素。结论:1、颅内肿瘤开颅手术患者医院感染发生率较高,主要感染部位是肺部。2、实施幕下肿瘤手术、术中输血、术后留置引流管时间大于2天、多次手术以及术后格拉斯哥昏迷评分(GCS)低是颅内肿瘤手术患者发生医院感染的独立危险因素,提示颅内肿瘤手术患者发生医院感染是多因素共同作用的结果。
[Abstract]:Objective: to investigate the incidence of nosocomial infection in patients with intracranial tumor after craniotomy, and to explore the risk factors of nosocomial infection in patients undergoing craniotomy and its preventive and therapeutic measures. Patients with intracranial tumors undergoing craniotomy from January 2014 to June 2016 in the affiliated Cancer Hospital of Guangxi Medical University were studied retrospectively. A total of 288 cases were collected. The incidence and location of nosocomial infection were analyzed. The distribution of pathogenic bacteria and the risk factors of nosocomial infection were analyzed by univariate and multivariate Logistic regression analysis. Results: from January 2014 to June 2016, a total of 288 patients undergoing intracranial tumor surgery were investigated. 136 male patients (47.22%) and 152 female patients (52.78%) had nosocomial infection, the youngest age was 6 years, the maximum age was 81 years, the mean age was 45.70 卤15.49 years. The infection rate was 14.24.The distribution of susceptible sites were as follows: lung infection in 27 cases, intracranial infection in 7 cases, intracranial infection in 7 cases, urinary tract infection in 3 cases, urinary tract infection in 3 cases, blood infection in 2 cases, and wound infection in 2 cases. The sputum, cerebrospinal fluid, incisional secretion, blood, and blood of 41 patients with nosocomial infection were infected by incision in 2 cases. A total of 17 strains of pathogenic bacteria were detected in urine, of which 7 were Gram-negative bacteria (41.18), 5 Gram-positive bacteria (29.41%) and 5 fungi (29.41%). Among them, Candida albicans were the first, followed by Staphylococcus aureus and Pseudomonas aeruginosa. The results of univariate analysis showed that the incidence of nosocomial infection in patients with intracranial tumors after operation was at the site of operation, operation time, indwelling drainage tube, blood transfusion during operation, times of operation. There was no significant difference in postoperative GCS score (P > 0.05) in sex, age, preoperative blood glucose, postoperative albumin, postoperative glucocorticoid use, operation site, operative time, indwelling drainage tube, and no significant difference was found in postoperative GCS score (P > 0.05), but there was no significant difference in terms of sex, age, preoperative blood glucose, postoperative albumin and postoperative glucocorticoid. Intraoperative blood transfusion, operation frequency and postoperative GCS score were risk factors for postoperative nosocomial infection in patients with intracranial tumor. Multivariate logistic regression analysis showed subtentorial operation, indwelling drainage tube for more than 2 days, blood transfusion during operation and multiple operations. Low postoperative GCS score was an independent risk factor for nosocomial infection in patients with intracranial tumors after craniotomy. Conclusion the incidence of nosocomial infection in patients with intracranial tumor craniotomy is higher than that in patients with intracranial tumor craniotomy. The main site of infection is pulmonary nosocomial nosocomial nosocomial infection (nosocomial infection). The duration of indwelling drainage tube was more than 2 days after operation, and the low GCSs and multiple operations were independent risk factors for nosocomial infection in patients with intracranial tumor surgery. The results suggest that nosocomial infection in patients undergoing intracranial tumor surgery is the result of multiple factors.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R739.41

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