经鼻蝶窦入路垂体瘤切除术后颅内感染病原学及其影响因素

目的探讨经鼻蝶窦入路垂体瘤切除术后并发颅内感染病原菌特征及影响因素。方法回顾性分析浙江省丽水市人民医院2014年1月-2019年2月500例经鼻蝶窦入路垂体瘤切除术患者临床资料,观察颅内感染发生情况,分析感染组感染病原菌分布情况及影响因素。结果500例经鼻蝶窦入路垂体瘤切除手术患者共有42例发生颅内感染,发生率为8.40%。年龄、肿瘤直径、手术时间、术中脑脊液漏、术后留置引流管是导致经鼻蝶窦入路垂体瘤切除术后颅内感染发生的独立危险因素;从42例感染患者脑脊液标本中共分离出51株病原菌,以凝固酶阴性葡萄球菌感染占比33.33%最高,其次为金黄色葡萄球菌、肺炎克雷伯菌、鲍氏不动杆菌;根据术后28 d患者临床结局,比较生存(n=493)和病死(n=7)患者,高龄、肿瘤直径较大、肿瘤具侵袭性、术后颅内感染患者的病死比例较高(P<0.05)。结论年龄、肿瘤直径、手术时间、术中脑脊液漏、术后留置引流管均是经鼻蝶窦入路垂体瘤切除术后颅内感染发生的影响因素,感染病原菌主要为凝固酶阴性葡萄球菌、金黄色葡萄球菌、鲍氏不动杆菌、肺炎克雷伯菌,术后颅内感染不利于患者预后。

Etiological characteristics and influencing factors for postoperative intracranial infection in nasal transsphenoidal pituitary tumor resection patients

OBJECTIVE To explore the etiological characteristics and influencing factors for postoperative intracranial infection in the nasal transsphenoidal pituitary tumor resection patients.METHODS The clinical data of 500 patients who underwent nasal transsphenoidal pituitary tumor resection in Lishui People’s Hospital from Jan 2014 to Feb 2019 were retrospectively analyzed,the incidence of intracranial infection was observed,and the influencing factors for the infection and distribution of pathogens were analyzed.RESULTS Of the 500 patients who underwent the nasal transsphenoidal pituitary tumor resection,42 had intracranial infection,with the incidence rate 8.40%.The age,tumor diameter,operation duration,intraoperative cerebrospinal fluid leakage and postoperative drainage tube indwelling were independent risk factors for the postoperative intracranial infection in the nasal transsphenoidal pituitary tumor resection patients.Totally 51 strains of pathogens were isolated from the cerebrospinal fluid specimens of 42 patients,coagulase-negative Staphylococcus(33.33%)was dominant among the isolated pathogens,followed by Staphylococcus aureus,Klebsiella pneumoniae and Acinetobacter baumannii.The patients were divided into the survival group with 493 cases and the death group with 7 cases according to the 28-day clinical outcomes,and the proportions of the patients who died with advanced age,larger diameter of tumor,invasive tumor and postoperative intracranial infection were significantly high(P<0.05).CONCLUSION The age,tumor diameter,operation duration,intraoperative cerebrospinal fluid leakage and postoperative drainage tune indwelling are the influencing factors for the postoperative intracranial infection in the nasal transsphenoidal pituitary tumor resection patients.Coagulase-negative Staphylococcus,S.aureus,A.baumannii and K.pneumoniae are dominant among the pathogens causing the infection,and the postoperative intracranial infection is not conducive to the prognosis of the patients.