"三步消毒法"降低脑室-腹腔分流术后颅内感染率初步效果观察

doi:10.3877/cma.j.issn.2095-9141.2021.02.010

中华神经创伤外科电子杂志 ›› 2021, Vol. 07 ›› Issue (02) : 107 -111. doi: 10.3877/cma.j.issn.2095-9141.2021.02.010

所属专题：文献；

颅脑创伤

"三步消毒法"降低脑室-腹腔分流术后颅内感染率初步效果观察

卢盛华¹, 赵志刚², 王学蛟³, 王翀昊⁴, 田润发¹, 王琳琳⁴, 李晶⁵, 牛非¹, 张斌¹, 刘佰运¹^,^†(

)

^1. 100070　北京市神经外科研究所中枢神经系统损伤研究北京市重点实验室和首都医科大学附属北京天坛医院神经外科
^2. 100070　北京，首都医科大学附属北京天坛医院药学部
^3. 037008　大同市第三人民医院神经外科
^4. 100070　北京，首都医科大学附属北京天坛医院神经外科
^5. 100070　北京，首都医科大学附属北京天坛医院手术室

收稿日期:2021-01-19 出版日期:2021-04-15
通信作者: 刘佰运
基金资助:
国家自然科学基金(81171144，81471238)

Clinical observation of "three-step disinfection" on reducing intracranial infection rate after ventriculo peritoneal shunt

Shenghua Lu¹, Zhigang Zhao², Xuejiao Wang³, Chonghao Wang⁴, Runfa Tian¹, Linlin Wang⁴, Jing Li⁵, Fei Niu¹, Bin Zhang¹, Baiyun Liu¹^,^†()

^1. Beijing Key Laboratory of Central Nervous System Injury and Department of Neurosurgery, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
^2. Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
^3. Department of Neurosurgery, Third People’s Hospital of Datong, Datong 037008, China
^4. Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
^5. Operating Room of Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China

Received:2021-01-19 Published:2021-04-15
Corresponding author: Baiyun Liu

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引用本文：

卢盛华, 赵志刚, 王学蛟, 王翀昊, 田润发, 王琳琳, 李晶, 牛非, 张斌, 刘佰运. "三步消毒法"降低脑室-腹腔分流术后颅内感染率初步效果观察[J]. 中华神经创伤外科电子杂志, 2021, 07(02): 107-111.

Shenghua Lu, Zhigang Zhao, Xuejiao Wang, Chonghao Wang, Runfa Tian, Linlin Wang, Jing Li, Fei Niu, Bin Zhang, Baiyun Liu. Clinical observation of "three-step disinfection" on reducing intracranial infection rate after ventriculo peritoneal shunt[J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2021, 07(02): 107-111.

目的

评价"三步消毒法"降低脑室-腹腔（V-P）分流术患者术后颅内感染率的效果，并对出现感染的原因进行初步分析。

方法

前瞻性单中心临床观察首都医科大学附属北京天坛医院神经外科自2019年4月至12月行V-P分流手术患者共69例，其中男性50例，女性19例，年龄范围18~77岁，年龄（54.32±11.52）岁，所有患者均采用"三步消毒法"进行术前消毒，观察患者围术期、术后6和12个月的颅内感染情况。随访采用术后病房观察，早期门诊复查，中远期电话随访相结合的方式，随访截止日期为2020年12月。

结果

本组69例患者均顺利完成手术，围术期未出现颅内感染病例，术后10 d~6个月出现颅内感染患者2例，术后6个月~1年无新发颅内感染患者。术后1年内累计颅内感染发生率为2.89%。

结论

初步观察"三步消毒法"可以降低V-P分流术后的颅内感染发生率，值得进一步进行大样本多中心的分组研究验证。

关键词: 脑室-腹腔分流术, 颅内感染, 术前消毒

Objective

To evaluate the effect of three-step disinfection on reducing intracranial infection rate in patients with ventriculo peritoneal (V-P) shunt, and analyze the causes of infection.

Methods

A total of 69 patients underwent V-P shunt surgery in Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University were prospectively observed in a single center from April to December 2019. There were 50 males and 19 females, ranging in age from 18 to 77 years old, with an age of (54.32±11.52) years old. All patients were disinfected with "three-step disinfection method" before operation, and the intracranial infection during perioperative period, 6 months and 12 months after operation were observed. The patients were followed up by inpatient observation, outpatient review and long-term telephone follow-up. The deadline of follow-up was December 2020.

Results

All the 69 patients in this study completed the operation successfully. There were no intracranial infection cases during the perioperative period. There were 2 patients experienced intracranial infection from 10 d to 6 months after operation, and no new intracranial infection patients occurred 6 months to 1 year after operation. The cumulative incidence of intracranial infection was 2.89%.

Conclusion

The research has preliminarily proved that the "three-step disinfection method" can reduce the incidence of intracranial infection after V-P shunt surgery, which is worthy of further validation by large sample multi-center randomized controlled trial.

Key words: Ventriculo peritoneal shunt, Intracranial infection, Disinfection

图1 "三步消毒法"流程图

图2 颅内感染患者术前术后的影像学资料

[1]	Reddy GK, Bollam P, Caldito G. Ventriculoperitoneal shunt surgery and the risk of shunt infection in patients with hydrocephalus: long-term single institution experience[J]. World Neurosurg, 2012, 78(1-2): 155-163.
[2]	Woo PY, Wong HT, Pu JK, et al. Primary ventriculoperitoneal shunting outcomes: a multicentre clinical audit for shunt infection and its risk factors[J]. Hong Kong Med J, 2016, 22(5): 410-419.
[3]	Kumar R, Younus SM, Haseeb A, et al. Frequency of infection associated with ventriculo-peritoneal shunt placement[J]. J Pak Med Assoc, 2016, 66(7): 815-818.
[4]	王凯，郝淑煜，张莹，等.脑室-腹腔分流术常见并发症原因分析[J].中华神经外科杂志, 2012, 28(12): 1246-1248.
[5]	Pelegrín I, Lora-Tamayo J, Gómez-Junyent J, et al. Management of ventriculoperitoneal shunt infections in adults: analysis of risk factors associated with treatment failure[J]. Clin Infect Dis, 2017, 64(8): 989-997.
[6]	Wong JM, Ziewacz JE, Ho AL, et al. Patterns in neurosurgical adverse events: cerebrospinal fluid shunt surgery[J]. Neurosurg Focus, 2012, 33(5): E13.
[7]	Qin B, Chen G, Chen J. Shunt infection in a single institute: a retrospective study[J]. Chin Neurosurg J, 2018, 4: 8.
[8]	Kumar V, Shah AS, Singh D, et al. Ventriculoperitoneal shunt tube infection and changing pattern of antibiotic sensitivity in neurosurgery practice: alarming trends[J]. Neurol India, 2016, 64(4): 671-676.
[9]	任晓辉，张扬，高之宪，等.神经外科术后颅内感染的影响因素及风险预测分析[J].中华神经外科杂志, 2015, 31(10): 992-996.
[10]	Kestle JR, Riva-Cambrin J, Wellons JR, et al. A standardized protocol to reduce cerebrospinal fluid shunt infection: the hydrocephalus clinical research network quality improvement initiative[J]. J Neurosurg Pediatr, 2011, 8(1): 22-29.
[11]	Kestle JR, Holubkov R, Douglas CD, et al. A new hydrocephalus clinical research network protocol to reduce cerebrospinal fluid shunt infection[J]. J Neurosurg Pediatr, 2016, 17(4): 391-396.
[12]	Heidari V, Habibi Z, Hojjati MA, et al. Different behavior and response of staphylococcus epidermidis and streptococcus pneumoniae to a ventriculoperitoneal shunt: an in vitro study[J]. Pediatr Neurosurg, 2017, 52(4): 257-260.
[13]	Yang YN, Zhang J, Gu Z, et al. The risk of intracranial infection in adults with hydrocephalus after ventriculoperitoneal shunt surgery: a retrospective study[J]. Int Wound J, 2020, 17(3): 722-728.
[14]	Sweeney J, Zyck S, Tovar-Spinoza Z, et al. Evidence-based perioperative protocol for ventriculoperitoneal shunt infection reduction at a single institution[J]. World Neurosurg, 2019, 128: e814-e822.
[15]	王娟，答蓉，王伟，等.分阶段氯己定消毒法对开颅手术患者头皮细菌的抑制效果[J].临床医学研究与实践, 2020, 5(2): 24-25, 40.
[16]	刘富蓉，龚仁蓉.开颅手术术前皮肤准备时机对颅内感染的影响[J].华西医学, 2017, 32(1): 95-97.
[17]	Saxena R, Mittal P, Clavaud C, et al. Comparison of healthy and dandruff scalp microbiome reveals the role of commensals in scalp health[J]. Front Cell Infect Microbiol, 2018, 8: 346.
[18]	Conrad JC, Poling-Skutvik R. Confined flow: consequences and implications for bacteria and biofilms[J]. Annu Rev Chem Biomol Eng, 2018, 9: 175-200.
[19]	Atemnkeng MA, Plaizier-Vercammen J, Schuermans A. Comparison of free and bound iodine and iodide species as a function of the dilution of three commercial povidone-iodine formulations and their microbicidal activity[J]. Int J Pharm, 2006, 317(2): 161-166.

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Clinical observation of "three-step disinfection" on reducing intracranial infection rate after ventriculo peritoneal shunt

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Clinical observation of "three-step disinfection" on reducing intracranial infection rate after ventriculo peritoneal shunt