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Czynniki ryzyka powikłań leczenia neurochirurgicznego

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Problemy z gojeniem ran to rzadkie, ale groźne powikłanie po zabiegach neurochirurgicznych. Szacuje się, że zakażenia miejsca operowanego mogą obejmować do 8 proc. pacjentów, którzy przeszli zabiegi w obrębie mózgoczaszki, oraz nawet 18 proc. pacjentów po operacjach w obrębie kręgosłupa. Jakie są przyczyny tych powikłań?

Zewnętrzne czynniki ryzyka powikłań leczenia neurochirurgicznego

Czynniki ryzyka powikłań infekcyjnych po zabiegach neurochirurgicznych są zróżnicowane i mają związek zarówno ze stanem zdrowia pacjenta, jak i z zewnętrznymi warunkami leczenia.

Wśród czynników związanych z zabiegiem operacyjnym wymienia się:

długość trwania zabiegu – im dłuższa operacja, tym większe ryzyko zakażenia i dłuższa ekspozycja miejsca operowanego na patogeny; większe ryzyko powikłań występuje dodatkowo w przypadku procedur wykonywanych etapowo;

tryb przeprowadzenia zabiegu – w przypadku zabiegów nagłych ryzyko powikłań jest większe;

czas przebywania pacjenta w oddziale szpitalnym przed zabiegiem oraz na oddziale intensywnej opieki w okresie pooperacyjnym – im okres hospitalizacji jest dłuższy, tym większe prawdopodobieństwo wystąpienia powikłań;

drenaż płynu mózgowo-rdzeniowego – CSF ma selektywne właściwości lityczne i rozpuszcza regenerującą tkankę łączną, dlatego jego wyciek może skutkować opóźnieniem gojenia ran operacyjnych, zakażeniem miejsca operowanego i innymi poważnymi powikłaniami;

duża utrata krwi podczas operacji oraz śródoperacyjna transfuzja krwi;

– stosowanie podczas zabiegu materiałów obcych (np. implantów, śrub, płytek, prętów) i drenów chirurgicznych.

Wewnętrzne czynniki ryzyka powikłań leczenia neurochirurgicznego

Do czynników związanych ze stanem zdrowia pacjenta zalicza się natomiast:

wiek;

płeć – bardziej narażeni na zakażenia pooperacyjne są mężczyźni;

przyjmowane leki – antybiotyki, chemioterapia i przewlekle stosowane steroidy działają immunosupresyjnie, co zwiększa ryzyko powikłań;

otyłość;

schorzenia współistniejące (m.in. cukrzyca, choroby autoimmunologiczne) oraz infekcje współistniejące w odległych od rany operacyjnej partiach ciała;

– występowanie choroby nowotworowej;

nosicielstwo bakterii Staphylococcus aureus (w tym szczepów MRSA) oraz Staphylococcus epidermidis – bakterie te stanowią składnik fizjologicznej flory skóry u ponad 30 proc. hospitalizowanych pacjentów;

alkoholizm i palenie tytoniu – według badań palenie tytoniu zwiększa ryzyko wystąpienia zakażenia miejsca operowanego nawet dwukrotnie;

wielokrotne leczenie neurochirurgiczne – badań pacjenci poddawani reoperacjom są bardziej narażeni na ryzyko powikłań z uwagi na występowanie blizn pooperacyjnych i pogorszony dopływ krwi do miejsca operowanego.

Źródło: M. Kołpa, M. Wałaszek, A. Maciejczak, „Zakażenia miejsca operowanego w chirurgii kręgosłupa – nadzór, czynniki ryzyka, profilaktyka antybiotykowa”, „Forum Zakażeń” 2018, 9(6): 361-368.

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229 thoughts on “Czynniki ryzyka powikłań leczenia neurochirurgicznego

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