张海兵 李青 朱治 夏卫东

[摘要]目的探討脑室外引流（EVD）继发颅内感染的危险因素。方法收集菏泽市立医院2015年10月至2020年10月行 EVD 治疗的154例患者的临床资料：病种、性别、年龄、糖尿病史、格拉斯哥评分（GCS）、气道外科操作、单双侧引流、脑室灌洗、肺部感染、尿激酶注入次数、置管时间、EVD 期血红蛋白（HGB）、白蛋白（ALB）及前白蛋白（PA）水平。所筛选病历于 EVD 治疗期未行其他硬膜下手术操作，根据是否感染分为颅内感染组与非感染组。对上述资料进行二分类单因素 logistic 回归分析，差异有统计学意义的因素代入二分类 logistic 多因素回归分析，筛选出颅内感染的独立危险因素。结果共19例出现颅内感染，感染率为12.3%，单因素 logistic 回归分析显示颅内感染组与非感染组在置管时间、PA 水平、气管切开及尿激酶注入次数比较差异有统计学意义（ P <0.05），代入 logistic 多因素回归分析显示：引流期 PA 偏低、气管切开及尿激酶注入次数为 EVD 继发颅内感染的独立危险因素。结论 EVD 期 PA 偏低、气管切开及尿激酶注入次数增加可能增加颅内感染的风险。[关键词]脑室外引流;颅内感染;气管切开;前白蛋白;危险因素

[中图分类号] R651.1 [文献标识码] A  [文章编号]2095-0616（2021）22-0149-05

Analysis of risk factors for intracranial infection secondary to simple external ventricular drainage

ZHANG  Haibing   LI  Qing   ZHU  Zhi   XIA  Weidong

The Third Disease Area of Neurosurgery， Brain Hospital of Heze Municipal Hospital， Shandong， Heze 274000， China

[Abstract] Objective To investigate the risk factors for intracranial infection secondary to external ventricular drainage （EVD）. Methods The clinical data of 154 patients undergoing EVD treatment in the Heze Municipal Hospital from October 2015 to October 2020 were collected， including disease type， gender， age， history of diabetes， Glasgow coma score （GCS）， surgical procedures for airway， unilateral and bilateral drainage， ventricular lavage， pulmonary infection， number of urokinase injections， intubation time， hemoglobin （HGB）， albumin （ALB） and prealbumin （PA） levels during EVD. The screened cases did not undergo other subdural surgical operations during the EVD treatment period and were divided into the intracranial infection group and the non-infection group according to the presence or absence of the intracranial infection. Binary univariate logistic regression analysis was performed on the above data， and factors with statistically significant differences were substituted into binary multivariate logistic  regression analysis to screen out independent risk factors for intracranial infection. Results A total of 19 cases suffered from intracranial infection， with an infection rate of 12.3%. The univariate logistic  regression analysis showed that there were statistically significant difference between the intracranial infection group and the non- infection group in terms of intubation time， PA level， tracheotomy and number of urokinase injections （P <0.05）. These factors with statistically significant differences were substituted into multivariate logistic  regression analysis， and the results showed that low PA during drainage， tracheotomy and number of urokinase injections were the independent risk factors for intracranial infection secondary to EVD. Conclusion Low PA level， tracheotomy and increased number of urokinase injections during EVD may increase the risk of intracranial infection.

[Key words] External ventricular drainage; Intracranial infection; Tracheotomy; Prealbumin; Risk factors

脑室外引流（external ventricular drainage， EVD）可快速有效的缓解脑卒中、脑外伤及脑肿瘤等引发的急性脑积水，也可辅助治疗腦室出血、脑室炎[1-2]以及监测颅内压，但手术引发颅内外环境相通也增加了颅内感染的风险，而感染一旦出现将增加致残率以及病死率[2-3]。近年来对 EVD 继发颅内感染的研究一直在进行，且部分研究结论得到了共识并应用于临床感染管理控制方案的优化，但大样本研究统计显示手术相关感染率仍未降至较低水平，部分研究结论也存在争议及不确定性，本研究收集我院单纯行EVD治疗患者的病例资料并分析总结相关数据，目的是排除其他颅内相关手术操作这一感染危险因素，进一步探讨 EVD 继发颅内感染的可能危险因素，为临床优化 EVD 感染防控提供进一步参考。……