本文選題：顱內腫瘤　切入點：開顱術　出處：《廣西醫(yī)科大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的:調查我院顱內腫瘤患者開顱術后醫(yī)院感染發(fā)生情況,探討顱內腫瘤開顱手術患者醫(yī)院感染的危險因素及其防治措施。方法:在參考國內外相關文獻資料的基礎上,以廣西醫(yī)科大學附屬腫瘤醫(yī)院2014年1月至2016年6月期間行開顱手術顱內腫瘤患者為研究對象,對其臨床資料進行回顧性調查,共收集病例288例,對醫(yī)院感染發(fā)生率、感染部位、病原菌分布以及醫(yī)院感染危險因素進行單因素和多因素Logistic回歸分析。結果:1、2014年1月至2016年6月共調查顱內腫瘤手術患者288例,其中男性患者136例(占47.22%),女性患者152例(占52.78%),手術患者中最小年齡6歲,最大81歲,平均年齡45.70±15.49歲。2、調查的288例患者中有41例發(fā)生醫(yī)院感染,感染率為14.24%;易感部位分布分別為:肺部感染27例(9.38%),顱內感染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例醫(yī)院感染患者的痰液、腦脊液、切口分泌物、血液、尿液中,共檢測出病原菌17株,其中革蘭陰性菌7株,占41.18%;革蘭陽性菌5株,占29.41%;真菌5株,占29.41%。其中白色念珠菌居首位,其次分別為金黃色葡萄球菌、銅綠假單胞菌、產(chǎn)ESBL大腸埃希菌。4、單因素分析結果顯示:顱內腫瘤術后患者醫(yī)院感染發(fā)生率在手術部位、手術時間、留置引流管、術中輸血、手術次數(shù)、術后GCS評分方面差異有統(tǒng)計學意義(P0.05);而在性別、年齡、術前血糖、術后白蛋白、術后應用糖皮質激素、手術季節(jié)方面差異無統(tǒng)計學意義(P〉0.05)。手術部位、手術時間、留置引流管、術中輸血、手術次數(shù)、術后GCS評分是顱內腫瘤患者術后醫(yī)院感染的危險因素。多因素logistic回歸分析顯示幕下手術、留置引流管時間大于2天、術中輸血、多次手術、術后GCS評分低是顱內腫瘤開顱術后患者醫(yī)院感染的獨立危險因素。結論:1、顱內腫瘤開顱手術患者醫(yī)院感染發(fā)生率較高,主要感染部位是肺部。2、實施幕下腫瘤手術、術中輸血、術后留置引流管時間大于2天、多次手術以及術后格拉斯哥昏迷評分(GCS)低是顱內腫瘤手術患者發(fā)生醫(yī)院感染的獨立危險因素,提示顱內腫瘤手術患者發(fā)生醫(yī)院感染是多因素共同作用的結果。
[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 鹵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.
【學位授予單位】：廣西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R739.41

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