Korinek A-M, Reina M, Boch A L, Rivera A O, De Bels D, Puybasset L
Neuroanaesthesia Unit, Department of Anaesthesiology, Pitié-Salpêtrière University Hospital, University of Paris VI, Paris, France.
Acta Neurochir (Wien). 2005 Jan;147(1):39-45; discussion 45-6. doi: 10.1007/s00701-004-0416-z.
The purpose of this study was to test if a reduction of external ventricular drains (EVD) related ventriculitis could be achieved by a strict protocol of care and if protocol violation was associated with a higher incidence of EVD-related ventriculitis.
A written protocol for EVD insertion, nursing and surveillance was implemented. A retrospective comparison of EVD-related ventriculitis incidence was performed between control (161 EVD in 131 patients) and study periods (216 EVD in 175 patients). Risk factor analysis was performed in patients in whom an EVD was inserted during the study period including the relationship between protocol compliance and ventriculitis. A score for the number of protocol violations (absence of hair clipping, absence of a tunnelled EVD, absence of shampooing, incorrect dressing change, inappropriate CSF bag or tap samplings and EVD manipulation) was established for each patient.
Incidence of patient-related ventriculitis decreased from 12.2% (1999) down to 5.7% (p<0.05) as well as incidence of EVD-related ventriculitis (9.9% vs 4.6%, p<0.05). During the study period, the only statistically significant risk factors for infection were CSF leak and protocol violations. The mean protocol violation score was 4 times higher in the infected versus the non-infected patients (p<0.0001). Patients with a violation score of 0 or 1 had no infection (EVD duration 2 to 42 days).
EVD can be left safely, as long as needed, provided that meticulous care is taken for EVD insertion and nursing. EVD duration seems to have no effect on infection incidence.
本研究旨在检验严格的护理方案是否能降低与外置脑室引流管（EVD）相关的脑室炎发生率，以及违反方案是否与EVD相关脑室炎的更高发生率相关。
实施了一份关于EVD插入、护理和监测的书面方案。对对照组（131例患者中的161根EVD）和研究期（175例患者中的216根EVD）的EVD相关脑室炎发生率进行回顾性比较。对研究期内插入EVD的患者进行危险因素分析，包括方案依从性与脑室炎之间的关系。为每位患者建立了违反方案次数的评分（未剪毛、未使用隧道式EVD、未洗头、换药不正确、脑脊液袋或穿刺采样不当以及EVD操作）。
患者相关脑室炎的发生率从1999年的12.2%降至5.7%（p<0.05），EVD相关脑室炎的发生率也从9.9%降至4.6%（p<0.05）。在研究期内，感染的唯一具有统计学意义的危险因素是脑脊液漏和违反方案。感染患者的平均违反方案评分比未感染患者高4倍（p<0.0001）。违反评分0或1的患者未发生感染（EVD留置时间2至42天）。
只要在EVD插入和护理时小心谨慎，EVD可根据需要安全留置。EVD留置时间似乎对感染发生率没有影响。
