标准化手术方案减少脑室--腹腔分流术后感染的临床研究

摘要

目的制订脑室-腹腔分流术标准化手术方案，观察其术后感染率。方法参考相关文献并结合本科室经验，制订标准化脑室-腹腔分流术手术方案治疗脑积水235例次（研究组），采用常规脑室-腹腔分流手术治疗脑积水117例次（对照组）。比较两组术后感染率并分析感染相关因素。结果研究组术后感染率为6．0％（14/235），明显低于对照组的12．8％（15/117）（P＜0．05）；研究组中以脑室外引流术后（有或无外引流后感染）再接受分流术患者的感染率最高（P＜0．05）。logistic回归分析发现，采用抗生素可吸收缝线缝合伤口患者感染风险更高（OR＝4．53，95％CI：1．43～14．41，P＝0．010）。结论脑室-腹腔分流术标准化手术方案可有效降低术后感染率；抗生素可吸收缝线是术后感染的危险因素。%Objective Todevelopastandardizedprotocolforventriculoperitonealshunt,andtoreducethe postoperativeinfectionrate.MethodsThestandardizedprotocolwasdevelopedbasedonthereferenceoftherelated literaturesandpriorinstitutionalexperience,whichwasappliedto235proceduresundergoingaventriculoperitoneal shunt(researchgroup),theregularprotocolwasappliedto117procedures(controlgroup).Acomparisonofpostoper-ativeinfectionratewasdonebetweentwogroups,andtherelatedfactorswereanalyzed.ResultsThepostoperative infectionrateintheresearchgroupwas6.0%(14/235),whichwassignificantlylowerthanthatinthecontrolgroup [12.8%(15/117)](P<0.05);Patientsundergoingshuntsurgeryafterexternalventriculardrainage(withorwithout priorinfection)hadthehighestinfectionrateintheresearchgroup(P<0.05).Logisticregressionanalysissuggested thattheuseofantibiotic-impregnatedabsorbablesuturewasassociatedwithanincreasedriskofinfection[OR=4.53, 95% confidenceinterval(CI):1.43-14.41,P=0.010].Conclusion Thestandardizedprotocolforventriculoperito-nealshuntsignificantlyreducesthepostoperativeinfectionrate;Theuseofantibiotic-impregnatedabsorbablesutureis theriskfactorofpostoperativeinfection.