西安交通大学学报（医学版）2024，Vol.45Issue(4)：645-649,5.DOI:10.7652/jdyxb202404018
经鼻颅底手术患者术中鼻腔细菌培养及临床分析
Bacterial culture and its clinical analysis of patients undergoing transnasal skull base surgery
摘要
Abstract
Objective To analyze the status of the bacteria in the operative area of transnasal skull base surgery and its correlation with postoperative intracranial infection.Methods The procedure of transnasal skull base surgery was divided into three stages:nasal passage preparation(stage 1),tumor resection(stage 2),and skull base reconstruction(stage 3).Bacterial sampling was taken from the mucosa of the anterior wall of sphenoid sinus or clival recess of sellar floor at the beginning of each stage;and the positive rate of bacterial culture in different stages of operation and its correlation with postoperative intracranial infection were analyzed.Results A total of 105 patients were enrolled in this study,and 315 samples were taken.The average time point of sampling in the three stages was 20.3,45.1 and 131.3 min after the beginning of operation,respectively.The positive results were 9 cases(2.9％)in the stage 1,8 cases(2.5％)in the stage 2,and 23 cases(7.3％)in the stage 3,which were 24 cases of Staphylococcus epidermidis,7 cases of Staphylococcus aureus,3 cases of hemolytic streptococcus,2 cases of Klebsiella pneumonia,and 4 cases of Escherichia coli.There was no significant difference in the positive cases between stage 1 and stage 2(P=0.955),but there were significant differences between stage 1 or 2 and stage 3(P=0.013;P=0.007).There were 36(11.4％)patients with at least one positive result in the three stages,17(16.2％)with cerebrospinal fluid leakage,and 12(11.4％)with intracranial infection.The risk of intracranial infection was 3.1 times higher in patients with positive bacterial culture than patients with negative bacterial culture(OR=3.1,95％CI:0.9-10.6),which was not statistically significant;patients with CSF leakage were 61.4 times higher than those without CSF leakage(OR=61.4,95％CI:11.2-337.1),which was statistically significant(P＜0.001).The consistency rate of bacteria in nasal cavity and postoperative cerebrospinal fluid culture was 57.1％.Conclusion The positive rate of bacterial culture in the operative area of transnasal skull base surgery increases significantly with the extension of operation time,which is a potential risk index of postoperative intracranial infection.关键词
内镜经鼻入路/细菌培养/颅内感染/消毒Key words
endoscopic transnasal approach/bacterial culture/intracranial infection/disinfection分类
医药卫生引用本文复制引用
张小荣,郭秀英,张琳娟,梅娜,李瑞春,冒平,高珂,宋莉..经鼻颅底手术患者术中鼻腔细菌培养及临床分析[J].西安交通大学学报（医学版）,2024,45(4):645-649,5.基金项目
陕西省自然科学基础研究计划项目(No.2023-JC-YB-720)Supported by the Natural Science Basic Research Project of Shaanxi Province(No.2023-JC-YB-720) （No.2023-JC-YB-720）
