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目的分析影响听神经鞘瘤术后颅内感染的危险因素,为临床预防和控制颅内感染提供依据。方法回顾性分析2007年2月至2015年2月于广东省第二人民医院就诊的305例听神经鞘瘤患者临床资料,并对发生感染的37例患者和未发生感染的268例患者临床资料、术后气管切开、手术情况、基础疾病、抗菌药物使用情况、激素使用情况等进行单因素和多因素Logistic回归分析。结果单因素分析结果显示,术后住院时间、年龄≥60岁、存在术后脑脊液漏、合并基础疾病、未使用抗菌药物、使用激素以及手术持续时间长患者发生感染现象多;采用多因素Logistic回归模型分析显示,术后脑脊液漏、合并有基础疾病、手术持续时间、使用激素等为听神经鞘瘤术后颅内感染的独立危险因素。37例颅内感染患者中共检出病原菌32株,其中革兰阴性菌18株,占56.25%;革兰阳性菌11例,占34.38%;真菌3株,占9.38%。结论影响听神经鞘瘤术后颅内感染因素主要有术后脑脊液漏、合并有基础疾病、手术持续时间、使用激素等,围术期应加强对上述因素的控制,以最大限度降低术后颅内感染现象发生。
Objective To analyze the risk factors of postoperative intracranial infection of acoustic nerve sheath tumors and provide the basis for clinical prevention and control of intracranial infection. Methods A retrospective analysis of clinical data of 305 patients with auditory nerve sheath tumors treated in the Second People’s Hospital of Guangdong Province from February 2007 to February 2015 was performed. Clinical data of 37 patients with infection and 268 patients without infection were retrospectively analyzed. Postoperative tracheotomy, surgical conditions, underlying diseases, antimicrobial use, the use of hormones and other univariate and multivariate logistic regression analysis. Results The results of univariate analysis showed that postoperative hospital stay, age ≥60 years, presence of postoperative cerebrospinal fluid leakage, combined with underlying diseases, no use of antimicrobial agents, hormones and long duration of surgery were more frequent in patients with infection. Multivariate Logistic regression Model analysis showed that postoperative cerebrospinal fluid leakage, combined with underlying diseases, duration of surgery, the use of hormones and other independent risk factors for postoperative intracranial infection of acoustic nerve sheath tumors. Among the 37 patients with intracranial infection, 32 strains of pathogens were detected, of which 18 strains were Gram-negative bacteria, accounting for 56.25%; 11 Gram-positive bacteria, accounting for 34.38%; 3 strains were fungi, accounting for 9.38%. Conclusions The main factors affecting intracranial infection of acoustic nerve schwannoma are postoperative cerebrospinal fluid leakage, combined with underlying diseases, duration of operation and the use of hormones. Perioperative management of these factors should be strengthened to minimize postoperative intracranial Infection occurs.