预防脑脊液分流感染的详细标准化方案。
Detailed standardized protocol to prevent cerebrospinal fluid shunt infection.
作者信息
Okamura Yuma, Maruyama Keisuke, Fukuda Shin, Horikawa Hiroshi, Sasaki Nobuyoshi, Noguchi Akio, Nagane Motoo, Shiokawa Yoshiaki
出版信息
J Neurosurg. 2019 Feb 15;132(3):755-759. doi: 10.3171/2018.10.JNS181432. Print 2020 Mar 1.
OBJECTIVE
While cerebrospinal fluid (CSF) shunt surgery plays an essential role in the treatment of hydrocephalus, postoperative infection due to the implantation of foreign materials is still one of the most common and potentially serious complications of this procedure. Because no previously reported protocol has been proven to prevent postoperative infection after CSF shunt surgeries in adults, the authors investigated the effectiveness of a protocol introduced in their institution.
METHODS
A detailed standardized surgical protocol to prevent infection in patients undergoing CSF shunt surgeries was introduced in the authors' institution in December 2011. The protocol included a series of detailed rules regarding the surgical procedure, the surgical environment to minimize contamination from air, double gloving, local injection of antibiotics, and postoperative management. The rate of CSF shunt infection during the 3 years after surgery before and after implementation of the protocol was compared in patients undergoing their first CSF shunt surgeries. The inclusion periods were from January 2006 to November 2011 for the preprotocol group and from December 2011 to December 2014 for the postprotocol group.
RESULTS
The study included 124 preprotocol patients and 52 postprotocol patients. The mean patient age was 59 years in both groups, ranging from 40 days to 88 years. Comparison of patient background factors, including known risk factors for surgical site infections, showed no significant difference between the patient groups before and after implementation of the protocol. While 9 patients (7.3%) developed shunt infections before protocol implementation, no shunt infections (0%) were observed in patients who underwent surgery after protocol implementation. The difference was statistically significant (p = 0.047).
CONCLUSIONS
The authors' detailed protocol for CSF shunt surgeries was effective in preventing postoperative infection regardless of patient age.
目的
虽然脑脊液分流手术在脑积水治疗中起着至关重要的作用，但由于植入异物导致的术后感染仍是该手术最常见且潜在严重的并发症之一。由于此前尚无已被证实能预防成人脑脊液分流手术后感染的方案，作者对其所在机构引入的一种方案的有效性进行了研究。
方法
2011年12月，作者所在机构引入了一项详细的标准化手术方案，以预防接受脑脊液分流手术患者的感染。该方案包括一系列关于手术操作、尽量减少空气污染的手术环境、双层手套、局部注射抗生素以及术后管理的详细规则。对接受首次脑脊液分流手术的患者，比较了该方案实施前后3年期间脑脊液分流感染率。纳入期为方案实施前组从2006年1月至2011年11月，方案实施后组从2011年12月至2014年12月。
结果
该研究纳入了124例方案实施前患者和52例方案实施后患者。两组患者的平均年龄均为59岁，范围从40天至88岁。对包括手术部位感染已知危险因素在内的患者背景因素进行比较，结果显示方案实施前后两组患者之间无显著差异。在方案实施前，有9例患者（7.3%）发生分流感染，而在方案实施后接受手术的患者中未观察到分流感染（0%）。差异具有统计学意义（p = 0.047）。
结论
作者的脑脊液分流手术详细方案在预防术后感染方面有效，与患者年龄无关。
Zotero 插件