河北医科大学学报 ›› 2022, Vol. 43 ›› Issue (6): 676-681.doi: 10.3969/j.issn.1007-3205.2022.06.012

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神经外科儿科重症监护室中患儿继发CNSI的危险因素分析

  

  1. 1.西南医科大学附属医院儿童重症监护病房，四川 泸州 646000；2.西南医科大学附属医院新生儿科，四川 泸州 646000
  • 出版日期:2022-06-25 发布日期:2022-06-29
  • 作者简介:张正霞（1991-），女，四川泸州人，西南医科大学附属医院主管护师，医学学士，从事儿科护理研究。
  • 基金资助:
    四川省自然科学基金项目（BK20191078）

Risk factors of secondary CNSI in pediatric intensive care unit in department of neurosurgery

  1. 1.Pediatric Intensive Care Unit, the Affiliated Hospital of Southwest Medical University, Sichuan Province， 
    Luzhou 646000， China; 2.Department of Neonatology, the Affiliated Hospital of Southwest Medical 
    University, Sichuan Province， Luzhou 646000， China
  • Online:2022-06-25 Published:2022-06-29

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摘要： 目的 分析神经外科儿科重症监护室（pediatric intensive care unit，PICU）患儿继发中枢神经系统感染（central nervous system infection，CNSI）的情况，并研究继发感染的危险因素。
方法 分析825例PICU患儿的临床资料，依据患儿的中枢神经感染情况分为CNSI组、未感染组。单因素分析2组患儿的指标差异，多因素Logistic分析神经外科PICU患儿继发CNSI的危险因素。
结果 神经外科PICU患儿的CNSI发生率为3.03%。CNSI组的年龄、合并糖尿病（diabetes mellitus，DM）、格拉斯哥昏迷量表（Glasgow Coma Scale,GCS）评分、白细胞减少、住院时长与未感染组差异均有统计学意义(P＜0.05)；CNSI组的手术时长、幕下开颅手术、Ⅰ类手术切口与未感染组差异均有统计学意义(P＜0.05)；CNSI组的侵入性操作、引流管留置部位、引流管留置时间与未感染组差异均有统计学意义(P＜0.05)；CNSI组的全身应用抗生素、金黄色葡萄球菌感染与未感染组差异均有统计学意义(P＜0.05)。PICU患儿发生CNSI的独立危险因素包括年龄＜8岁、合并糖尿病、GCS评分＜8分、白细胞减少、住院时间≥10 d、手术时间≥4 h、幕下开颅手术、侵入性操作、脑室外留置引流管、引流管留置时间≥7 d、全身应用抗生素、金黄色葡萄球菌感染(P＜0.05)。
结论 神经外科PICU患儿发生CNSI的危险因素较多，应优化手术方案，实现个性化治疗，缩减手术时间与住院周期，规范进行侵入性操作，定时进行留置管防感染工作，合理应用抗生素，有效预防CNSI的发生。

关键词:


Abstract: Objective To analyze the situation of secondary central nervous system infection(CNSI) in Pediatric Intensive Care Unit(PICU) in Department of Neurosurgery, and to study the risk factors for secondary infection.
Methods The clinical data of 825 children in PICU were analyzed. The children were divided into CNSI group and non-CNSI group according to their CNSI. Univariate analysis was performed for the differences in indicators between two groups, and multivariate Logistic analysis was performed for the risk factors of secondary CNSI in children in PICU in Department of Neurosurgery. 
Results The incidence of CNSI in children in PICU in Department of Neurosurgery was 3.03%. There were significant differences in age, concomitant diabetes mellitus(DM), Glasgow Coma Scale(GCS) score, leucopenia, length of hospital stay between the CNSI group and the non-CNSI group(P＜0.05). There were statistically significant differences in the duration of operation, subtentorial craniotomy, typeⅠ surgical incision between the CNSI group and the non-CNSI group(P＜0.05). There were significant differences in invasive operation, indwelling site and indwelling time between the CNSI group and the non-CNSI group(P＜0.05). Significant differences were found in systemic antibiotics and staphylococcus aureus infection between the CNSI group and the non-CNSI group(P＜0.05).The independent risk factors for CNSI in patients in PICU included age<8 years, concomitant DM, GCS score＜8 points, leukopenia, length of hospital stay≥10 d, or duration ofoperation≥4 h, subtentorial craniotomy, invasive operation, indwelling drainage tube outside the ventricle,drainage tube indwelling time≥7 d, systemic application of antibiotics, or staphylococcus aureus infection. 
Conclusion There are various risk factors for CNSI in children in PICU in Department of Neurosurgery. Therefore, optimized surgical plan, personalized treatment, reduced duration of operation and length of hospital stay, standardized invasive operation,regular infection prevention of indwelling tube, and rational use of antibiotics can effectively prevent the occurrence of CNSI.


Key words: central nervous system infection, intensive care unit, pediatric, risk factors

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