Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA.
Neurosurg Focus. 2012 Nov;33(5):E8. doi: 10.3171/2012.8.FOCUS12245.
Neurosurgical patients are at a high risk for infectious sequelae following operations. For neurosurgery in particular, the risk of surgical site infection has a unique implication given the proximity of the CSF and the CNS. Patient factors contribute to some degree; for example, cancer and trauma are often associated with impaired nutritional status, known risk factors for infection. Additionally, care-based factors for infection must also be considered, such as the length of surgery, the administration of steroids, and tissue devascularization (such as a craniotomy bone flap). When postoperative infection does occur, attention is commonly focused on potential lapses in surgical "sterility." Evidence suggests that the surgical field is not free of microorganisms. The authors propose a paradigm shift in the nomenclature of the surgical field from "sterile" to "clean." Continued efforts aimed at optimizing immune capacity and host defenses to combat potential infection are warranted.
神经外科患者在手术后易发生感染性后遗症。对于神经外科来说，由于 CSF 和 CNS 位置接近，手术部位感染的风险具有独特的意义。患者因素在一定程度上促成了感染的发生；例如，癌症和创伤通常与营养状况受损有关，这是感染的已知危险因素。此外，还必须考虑与护理相关的感染因素，如手术时间、类固醇的使用以及组织血运减少（如开颅骨瓣）。当术后发生感染时，通常会关注手术“无菌”方面是否存在疏漏。有证据表明手术区域并非没有微生物。作者建议将手术区域的命名从“无菌”改为“清洁”。值得继续努力优化免疫能力和宿主防御以对抗潜在感染。
