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Objective To analyze the characteristics of lower respiratory tract infection occurring in patients after craniocerebral surgery in Intensive Care Unit (ICU) and explore its nursing countermeasures. Methods Sixty-eight patients with lower respiratory tract infection after craniocerebral surgery in the ICU of the First Affiliated Hospital of Wenzhou Medical University from January 2015 to March 2016 were selected as the study subjects. All patients were treated with dehydration to reduce intracranial pressure, hemostasis, anti-infection, anti-epilepsy, mild hypothermia, hypoglycemia and other symptomatic supportive treatments, and the corresponding nursing measures were given. The patients' primary diseases and etiological examination results were analyzed. Results Of the 68 patients complicated with lower respiratory tract infection after craniocerebral surgery, the majority of primary disease was craniocerebral injury, accounting for 45.59% (31/68). A total of 127 strains of pathogenic bacteria were isolated, mainly Gram-negative (G-) bacteria [92 strains (accounting for 72.44% )];followed by Gram-positive (G+) bacteria [19 strains (accounting for 14.96%)] and fungi [16 strains (accounting for 12.60%)]. The main pathogens of G- were Acinetobacter baumannii 21 strains (accounting for 23.14%), Klebsiella pneumoniae 13 strains (accounting for 14.94%), Burkholderia cepacia 10 strains (accounting for 11.49%), Pseudomonas aeruginosa 8 strains (accounting for 11.49%); the main pathogens of G+ was Staphylococcus aureus 6 strains (accounting for 5.89%). Conclusion The incidence of lower respiratory tract infection in ICU patients after craniocerebral surgery is high. It is necessary to prevent and control the related risk factors as soon as possible, and take energetic and effective nursing measures to reduce the incidence of lower respiratory tract infection.
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Objective To study the effect of operating rooms of two different cleanliness on surgical site infection (SSI)in neurosurgical craniocerebral operation,provide reference for the prevention and control of SSI.Methods Neurosurgical craniocerebral operation undertaking in grade I and II operating rooms in a hospital between July 2015 and July 2016 was performed retrospective study,patients in grade I operating rooms were as control group and those in grade II operating rooms were as trial group,occurrence of SSI was compared between two groups of pa-tients.Results A total of 454 patients undergoing craniocerebral operation were investigated,212 patients were in control group (grade I operating rooms)and 242 in trial group (grade II operating rooms).Patients in control group had 25 cases of SSI,incidence of SSI was 11.79%;trial group had 31 cases of SSI,incidence of SSI was 12.81%. Nine cases of SSI were superficial incision infection,there was no deep incision infection,the other 47 cases of SSI were intracranial infection(organ space infection).There was no significant difference in the incidence of SSI be-tween two groups of patients(P＞0.05).Conclusion Grade I and II cleanliness operating rooms have no direct effect on SSI in patients undergoing neurosurgical craniocerebral operation,comprehensive prevention and control mea-sures should be taken to prevent the occurrence of SSI.
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Objective To explore risk factors for healthcare-associated infection (HAI)in patients undergoing craniocerebral operation,and provide guidance for the prevention of HAI in patients in department of neurosurgery. Methods 200 patients who underwent craniocerebral operation in a department of neurosurgery from November 2013 to November 2014 were surveyed,risk factors for HAI were analyzed.Results Among 200 patients undergo-ing craniocerebral operation,81 patients developed 99 cases of HAI,HAI rate was 40.50%,HAI case rate was 49.50%;the top five HAI sites were lower respiratory tract,urinary tract,intracranial site,bloodstream,and in-testinal tract.Univariate analysis showed that patients’age ≥60,Glasgow Coma Scale (GCS)<15,intraoperative blood loss ≥800 mL,staying in intensive care unit(ICU),indwelling gastric tube,ventricular drainage,using ventilator,tracheotomy,and using H2 receptor antagonists were important risk factors for HAI in patients undergo-ing craniocerebral operation (all P <0.05).Multivariate logistic regression analysis showed that patients’age ≥60, GCS<15,staying in ICU,and using H2 receptor antagonists were independent risk factors for HAI in patients un-dergoing craniocerebral operation.Conclusion Strengthening the surveillance of HAI patients undergoing cranioce-rebral operation and realizing risk factors for HAI are helpful for taking comprehensive prevention measures and re-ducing the incidence of HAI.
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Objective To observe the effect of metoclopramide combined with early enteral nutritional on patients with mechanical ventilation after craniocerebral operation.Methods A prospective randomized control study was conducted.56 patients with mechanical ventilation after craniocerebral operation were randomly divided into metoclopramide combined with early enteral nutritional group (observation group) and parenteral nutrition group (control group),28 in each group.The patients in the observation group received early enteral nutrition (24-48 h after operation),and intramuscular injection of metoclopramide (10mg Q8H) for 7 days.The patients in the control group received parenteral nutrition.The nutritional parameters,mechanical ventilation (MV) time,success rate of the ventilator weaning and the occurrence rate of pneumonia associated with ventilation (VAP) in one week,the incidence of adverse reaction were compared between the two groups.Results After 1 week therapy,the nutritioual parameters of the two groups showed no statistical significance(P ＞ 0.05);the observation group compared with the control group,3 、7days of blood glucose(P1 、P2) decreased significantly[(8.9 ± 1.6) mmol/L vs (11.4 ± 3.2) mmol/L,(8.2 ± 1.3) mmol/L vs (10.6 ± 2.1) mmol/L] (P1 =0.002,P2 =0.011),Mechanical ventilation (MV) time (P3) and the occurrence rate of VAP(P4) in one week also declined[(6.5 ±2.3)d vs (8.9 ±3.1)d,21.4％ vs 46.4％] (P3 =0.022,P4 =0.048),but within a week of success rate of the ventilator weaning improved (67.9％ vs 39.3％,P5 =0.032).Return rate (P6),gastrointestinal bleeding (P7) was significantly lower than those of the control group (17.9％ vs 42.9％,14.3％ vs 42.9％,P6 =0.042,P7 =0.038),but abdominal distention,diarrhea were no significant contrast (P ＞ 0.05).Conclusion Metoclopramide combined with early enteral nutritional may obviously improve the nutrition parameters,shorten the MV time,decrease the occurrence rate of VAP,not increase in side effects.
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Objective To investigate the effect of chlorhexidine gluconate in prevention of surgical site infection ( SSI ) . Methods Randomized controlled clinical trial method was used in the study. Comparison was made in the rates of SSI between the experiment group using 2% chlorhexidine gluconate and the control group. Results The rate of SSI in experiment group was significantly lower than that in control group (0.83% vs.5.83%, χ2 =3.23,P =0.035).Differences of hospital stay, total cost, infection in other sites and mortality rate of SSI were not statistically significant between the two groups ( P>0 .05 ) . Conclusion Preoperative head disinfection by chlorhexidine gluconate has remarkable effect in prevention of cerebral surgical site infection.
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Objective To investigate risk factors for healthcare-associated infection(HAI)in patients with craniocerebral operation,and provide reference for the prevention and control of HAI.Methods A total of 4 246 cases of craniocerebral surgery in a neurosurgery department from January 2010 to December 2012 were enrolled in the study,the risk fac-tors for HAI were analyzed.Results Of 4 246 cases of craniocerebral surgery,393 patients developed 446 times of post-operative HAI,HAI incidence rate was 9.26%,case infection rate was 10.50%,which were higher than inci-dence (2.02%)and case infection rate (3.02%)of HAI of all hospital during the same period,the difference was statistically significant (χ2 =811 .06,629.30,respectively,P 7 d,antimicrobial use >7 d,central venous and urinary tract cathe-terization,invasive ventilator were risk factors for HAI in patients with craniocerebral operation.Conclusion The incidence of HAI in patients with craniocerebral operation is high,effective preventive and control measures accord-ing to risk factors should be strengthened to reduce the incidence of HAI.
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Objective To study the effect and safety on the retention respiratory inhalation general anesthesia in craniocerebral operation.Methods Eighty-six patients undergoing craniocerebral operation were divided into conventional anesthesia group (group A) and retention respiratory anesthesia group (group B) by random digits table method with 43 cases each.Group A was given conventional induction and intubation,administration order:midazolam 0.05 mg/kg,fentanyl 2-4 μ g/kg,cisatracurium 0.2-0.3 mg/kg,propofol 1.0-1.5 mg/kg;group B was given rapid induction and intubation,administration order:midazolam 0.05 mg/kg,fentanyl 2-4 μg/kg,propofol 1.0-1.5 mg/kg,succinylcholine 1.5 mg/kg.The 2 groups after intubation done by Ohmeda 7100 anesthesia machine control respiration,trace pump continuous infusion of propofol and remifentanil,and maintained inhaling isoflurane anesthesia.Group A was discontinuity intravenous injection atracurium.Group B was changed autonomous breathing after the succinylcholine effect disappeared,respiratory frequency according to the regulation of remifentanil infusion rate,the respiration rate remained at 8-12 times/min.The consumption of propofol and remifentanil,additional times of fentanyl,intraoperative airway pressure,partial pressure of carbon dioxide in end expiratory gas (PE TCO2),intraoperative body movement,airway pressure,extubation time,OAA/S score after extubation 15 min and untoward reaction were recorded.Results There were no statistical differences in operation time,intraoperative body movement,intraoperative airway pressure and PETCO2 between the 2 groups (P＞ 0.05).The consumption of propofol and remifentanil,additional times of fentanyl in group B were significantly higher than those in group A [(69.2 ± 13.7) μg/(kg·min) vs.(61.0 ± 8.2)μg/(kg·min),(0.19 ± 0.06) μ g/ (kg· min) vs.(0.15 ± 0.05) μ g/ (kg· min),1.5 times vs.0 time],there were statistical differences (P＜ 0.05).The extubation time in group B was significantly shorter than that in group A [(6.4 ±3.2) min vs.(11.3 ± 4.5) min],the OAA/S score after extubation 15 min in group B was significantly lower than that in group A [1 (1-3) scores vs.2(1-3) scores],there were statistical differences between the 2 groups (P ＜ 0.05).Conclusion Retention respiration intubation general anesthesia patients of craniocerebral operation can early recover,extubation time is significantly shorter,it is a safe and effective anesthesia method.
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Objective To investigate the application of ultrasound localization during craniocerebral operations. Methods Thirty-one cases with intracranial space occupying lesion were surgically treated with guidance of ultrasound, which was applied to real-time localization while revealing skull, tracing during operation and evaluation of the operation's effect before locking up the skull. Results In our group, 31 cases were checked using ultrasound localization during operation. Ultrasound could level the lesion's size and position, which was in accordance with the result of CT and MRI before operation. With the application of ultrasound localization, the lesion could be probed exactly. Conclusions Ultrasound localization during operation is simple, effective and secure, and is helpful to enhance the accuracy of the craniocerebral operations, reduce the blindly exploration, shorten the operation time, and what is more important, reduce unnecessary tissue damage of normal brain tissue, which obviously possess much clinical utilization.
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[Objective]To study the risk factors of neurosurgical postoperative intracranial infection.[Methods]Analyse 30 cases of intracranial infection after the neurosurgery operation from 2003 to 2008 in our department.[Results]The intracranial infections after craniocerebral operation is related to the operation duration,cerebrospinal fluid leakage,external ventricular drainage,laying the drainage-tube,open craniocerebral injury.[Conclusion]To shorten the operation time as long as possible,tighten dural closure to prevent leakage of cerebrospinal fluid,with strict control of the indwelling time, reduce the number of drainage-tube and shorten indwelling time after neurosurgery operation as possible as we can,can reduce the possibility of intracranial infection after neurosurgery operation.
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OBJECTIVE To analyze the correlation factors of nosocomial infection in patients after receiving craniocerebral operation.METHODS Totally 388 hospitalized patients after receiving craniocerebral operation from Jan 2006 to Dec 2006 were studied retrospectively.RESULTS From them 45 pateints were suffering from nosocomial infection and total incidence of nosocomial infection was 11.59%.Among them,60.0% was lower respiratory tract infection,11.11% was surgical wound infection and 8.89% was upper respiratory infection.Aging,length of stay and invasive operation(deep vein needle detaining,trachea incision,tracheal intubation,urinary canal and drainage tube dwelling) were the main correlation tactors.CONCLUSIONS Minimizing invasive operation and early removing various kinds of dwelling tubes,using antibiotics correctly,improving hospitalizd environment and strengthening wards management are the measures to reduce nosocomial infection according its correlation factors.
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Objective: To study the changes of blood concentration of glucose and insulin during brain tumor resection under propofol or isoflurane anesthesia.Methods:Thirty patients scheduled for brain tumor resection were randomized to propofol group (n=15) and isoflurane group (n=15) respectively.Venous blood samples were taken for the measurement of blood concentration of glucose and insulin before induction,after intubation,at 30 and 60 min during anesthetic maintenance respectively.Results:Blood concentration of glucose in propofol group and blood concentration of insulin in isoflurane group were not significantly changed.In isoflurane group,however,blood concentration of glucose increased significantly at 30,60min,( P