Clinical Study Of Vancomycin Intracranial Irrigation During Operation To Reduce Postoperative Intracranial Infection

Objective: With the continuous popularization of neurosurgical techniques,postoperative intracranial infection has become a common complication of neurosurgery and afflicts every clinician.The study found that postoperative intracranial infections were mainly methicillin-resistant Staphylococcus aureus.At present,vancomycin is still an effective drug for the treatment of methicillin-resistant Staphylococcus aureus.This study was to investigate the clinical study of the use of vancomycin in intracranial irrigation to reduce the incidence of intracranial infection.At the same time,the clinical study of intraoperative vancomycin flushing and postoperative convulsion was discussed.Methods: A total of 379 hospitalized patients from January 2015 to January 2016 and October 2016 to January 2017 were retrospectively collected,and 113 patients were finally included in the exclusion criteria.This study collect the research information of all clinical subjects,and all patients are able to find out the detailed medical record information through the Kyrgyzstan first hospital medical record retrieval system.According to the actual conditions of the subjects,the patients’ gender,age,pathological type,operation site(supratentorial surgery),postoperative intracranial infection(infection / noninfected),operation time(3 hours,3-5 hours,≥ 6 hours),cerebrospinal fluid leakage after surgery,indwelling cerebral venous drainage tube,whether preoperative diabetes mellitus,hypertension,preoperative albumin level(<40 g / L,≥40 g / L)The location of the deep,shallow,tumor size(<5cm,≥ 5cm),intraoperative prevention and treatment of antibiotic grade(low / high),postoperative convulsions and so on.According to intraoperative intracranial irrigation with vancomycin is divided into control group and observation group.Observe and record the occurrence of postoperative intracranial infection and intracranial vancomycin intracranial irrigation,while recording the incidence of convulsions after intracranial irrigation frequency distribution.Results:A total of 113 patients were included in the study,including 50 males(44.2%)and 15 infected persons.The infection rate was 30%(15/50),63 females(55.8%),and the number of infections was 4.The infection rate was 6.3.%(4/63).The age range of the subjects in this study ranged from 2 years to 77 years(minimum age 2 years,maximum age 77 years).The age was divided into 3 groups: 31 persons in the <40 age group(27.4%),7 infections,infection rate of 22.6%(7/31),46(40.7%)in the 45-60 age group,and the number of infections Three people had an infection rate of 6.5%(3/46),a total of 36(31.9%)in the age group of 60,and 9 people with an infection rate of 25%(9/36).The number of patients with vancomycin intracranial washing was 53,and the number of infected persons was 4.The infection rate was 7.5%(4/53).The number of patients using normal saline was 60,the number of infected persons was 15,and the infection rate was 25%(15 /60).In this study,gender,age,tumor properties,blood glucose,blood pressure,operation time and other factors were included in logistic regression analysis to analyze the factors that affect the postoperative intracranial infection.The results suggest that gender,age,tumor properties,location of lesions from the surface of the brain,postoperative cerebrospinal fluid leakage,drainage outside the brain,operation time,and intracranial flushing are associated with intracranial infection.Using multivariate logistic regression analysis,independent risk factors for intracranial infection after craniotomy were explored.The patient’s gender,postoperative cerebrospinal fluid leakage,and intraoperative intracranial irrigation were independent risk factors for postoperative intracranial infection.The risk of postoperative intracranial infection in women was 0.07 times that of men(OR=0.07,95% CI: 0.02-0.37,P=0.002).At the same time,the risk of postoperative infection in patients with cerebrospinal fluid leakage was 28.99 times the risk of postoperative cerebrospinal fluid leakage(OR=28.99,95%CI:4.32-194.33,P=0.001).The risk of postoperative intracranial infection in patients who were finally treated with vancomycin for intracranial irrigation was a 82% reduction in patients who received saline(OR=0.18,95% CI: 0.04-0.73,P=0.017).Conclusion:1.Intracranial irrigation with vancomycin can reduce the incidence of postoperative intracranial infection for patients with craniocerebral surgery.2.At the same time with vancomycin flushing will not lead to an increase in postoperative convulsions...