Related factors of postoperative infection and improvement of surgical operation after ventriculoperitoneal shunt

doi:10.3877/cma.j.issn.1674-1358.2017.03.019

Abstract

Abstract:

Objective

To analyze the related factors of postoperative infection after ventriculoperitoneal shunt (VPS) and to provide the basis for the effective prevention and control of postoperative infection; and to explore the methods to improve the operation for reducing the rate of postoperative infection.

Methods

Total of 290 cases were selected as the improved group who were given improvement of conventional VPS in the treatment of hydrocephalus, while 188 cases with the conventional treatment of hydrocephalus were selected as the control group, the rate of postoperative infection were compared between the two groups. The age distribution, hydrocephalus type, preoperative status of different factors between the incidence of postoperative infection, and the infection factors of patients in the improved group were analyzed by SPSS 20.0 statistical analysis software, while the related factors of postoperative infection were analyzed.

Results

Among the modified group, 202 patients were treated with modified VPS for 290 times, and the infection rate was 6.55% (19/290). The control group of 138 patients, the use of conventional VPS 188 case-times, the infection rate was 13.83% (26/188), the postoperative infection rate of the modified group was significantly lower than that of the control group (χ² = 5.022, P = 0.021). The early infection in the modified and control groups were 13 (68.42%) and 20 (76.92%), respectively, but with no significant differences (χ² = 0.724, P = 0.415). The early infection in the modified and control groups were 13 (68.42%) and 20 (76.92%), respectively, with significant differences (χ² = 10.131, P = 0.001). Prophylactic use of antimicrobial agents (χ² = 4.297, P = 0.039), complete preservation of periosteum and suture, embedding of puncture holes (χ² = 8.924, P = 0.005) and small arc head skin incision (χ² = 7.209, P = 0.015) were associated with postoperative infection.

Conclusions

Prophylactic use of antibiotics, complete preservation of periosteum and suture embedding puncture holes, small arc head skin incision were all the protective factors of postoperative infection, which were helpful to reduce the rate of postoperative infection.

Key words: Hydrocephalus, Ventriculoperitoneal shunt, Operation improvement, Infection

Bing Li. Related factors of postoperative infection and improvement of surgical operation after ventriculoperitoneal shunt[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2017, 11(03): 297-301.

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References 26

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指标		改良组（202例）	对照组（138例）	χ²值	P值
性别				0.022	0.861
	男	118（58.4）	78（56.5）
	女	84（41.6）	60（43.5）
年龄（岁）				0.031	0.843
	< 1	42（20.8）	26（18.8）
	≥ 1	160（79.2）	112（81.1）
脑积水类型				0.009	0.975
	梗阻性	122（60.4）	104（75.4）
	交通性	80（39.6）	34（24.6）
术前情况				0.334	0.198
	首次行VPS	116（57.4）	74（53.6）
	脑室外引流后行VPS	30（14.9）	22（15.9）
	感染控制后行VPS	34（16.8）	24（17.4）
	再次行VPS	22（10.9）	18（13.0）

指标		改良组（202例）	对照组（138例）	χ²值	P值
性别				0.022	0.861
	男	118（58.4）	78（56.5）
	女	84（41.6）	60（43.5）
年龄（岁）				0.031	0.843
	< 1	42（20.8）	26（18.8）
	≥ 1	160（79.2）	112（81.1）
脑积水类型				0.009	0.975
	梗阻性	122（60.4）	104（75.4）
	交通性	80（39.6）	34（24.6）
术前情况				0.334	0.198
	首次行VPS	116（57.4）	74（53.6）
	脑室外引流后行VPS	30（14.9）	22（15.9）
	感染控制后行VPS	34（16.8）	24（17.4）
	再次行VPS	22（10.9）	18（13.0）

指标		手术例数	感染例数	感染率（%）	χ²值	P值
年龄（岁）					10.131	0.001
	< 1	68	10	14.71
	≥ 1	222	9	4.05
脑积水类型					1.209	0.275
	梗阻性	160	11	6.88
	交通性	130	8	6.15
术前情况					8.034	0.041
	首次行VPS	116	6	5.17
	脑室外引流后行VPS	30	4	13.33
	感染控制后行VPS	34	5	14.71
	再次行VPS	110	4	3.64

指标		手术例数	感染例数	感染率（%）	χ²值	P值
年龄（岁）					10.131	0.001
	< 1	68	10	14.71
	≥ 1	222	9	4.05
脑积水类型					1.209	0.275
	梗阻性	160	11	6.88
	交通性	130	8	6.15
术前情况					8.034	0.041
	首次行VPS	116	6	5.17
	脑室外引流后行VPS	30	4	13.33
	感染控制后行VPS	34	5	14.71
	再次行VPS	110	4	3.64

影响因素	实施			未实施			χ ²值	P值
影响因素	例数	感染例数	感染率（%）	例数	感染例数	感染率（%）	χ ²值	P值
手术当日术区备皮	261	17	6.51	29	2	6.90	0.131	0.901
术区无菌保护膜	250	16	6.40	40	3	7.50	0.225	0.831
小的弧形头部皮肤切口	220	10	4.55	70	9	12.86	7.209	0.015
预防性使用抗菌药物	269	15	5.58	21	4	19.05	4.297	0.039
骨膜完整保留及缝合包埋	234	10	4.27	56	9	16.07	8.924	0.005
抗菌药物灌洗分流阀贮液囊	240	15	6.25	50	4	8.00	0.375	0.671

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