产后宫内感染的影响因素及病原菌分析  

Clinical characteristics of postpartum intrauterine infections and distribution of pathogens

作　　者：冯娟[1] 罗萍[2] 陈惠丽[1] 王仁媛[3] 黄小慧 

机构地区：[1]海南省妇幼保健院产科,海南海口570206 [2]海南省妇幼保健院妇保科,海南海口570206 [3]海南省妇幼保健院护理部,海南海口570206

出　　处：《中华医院感染学杂志》2017年第17期3986-3988,3992,共4页Chinese Journal of Nosocomiology

摘　　要：目的分析产后宫内感染的临床特征及病原菌分布,为宫内感染的预防和控制提供客观依据。方法选取2013年3月-2016年12月在医院住院分娩的产妇3 128例为研究对象,统计产后宫内感染的发生率,并对引发宫内感染的危险因素进行单因素和多因素logistic回归分析;分析感染产妇的临床表现及送检标本的病原菌分布。结果 3 128例产妇中共有191例发生宫内感染,感染率为6.11%;单因素分析结果显示,孕期、妊娠期并发症情况、胎膜早破、宫内感染史与产后宫内感染具有相关性(P<0.05);多因素logistic回归分析结果显示,妊娠并发症、胎膜早破、宫内感染史是发生产后宫内感染的独立危险因素(χ~2=16.397、28.669、37.036,P<0.05);在191例产后宫内感染患者中,最常见的临床症状是发热和恶露不清,发生率分别为83.2%和67.5%;191例宫内感染产妇送检标本中有162例检出病原菌,检出率为84.8%;共分离出209株病原菌,其中,革兰阴性菌99株占47.4%,革兰阳性菌69株占33.0%,真菌41株占19.6%,主要病原菌为大肠埃希菌、表皮葡萄球菌、白假丝酵母,分别占26.8%、18.2%、16.3%。结论产后宫内感染的临床表现、相关因素和病原菌分布均有一定的特征性,临床医师应对具有高危因素的孕产妇给予密切关注和有效干预,从而降低宫内感染对母婴结局的不良影响。OBJECTIVE To investigate the clinical characteristics of postpartum intrauterine infections and analyze the distribution of pathogens so as to provide objective basis for prevention and control of the intrauterine infections.METHODS A total of 3 128 pregnant women who were hospitalized and gave birth in the hospital from Mar 2013 to Dec 2016 were recruited as the study objects,the incidence rate of postpartum intrauterine infections was statistically analyzed,and the univariate analysis and multivariate logistic regression analysis were performed for the risk factors for the intrauterine infections.RESULTS Of the 3 128 pregnant women,191 had the intrauterine infections,with the infection rate 6.11%.The result of the univariate analysis showed that the postpartum intrauterine infections was associated with gestational weeks,gestational complications,premature rupture of membranes and history of intrauterine infections（P〈0.05）.The result of the multivariate logistic regression analysis indicated that the gestational complications,premature rupture of membranes and history of intrauterine infection were the independent risk factors for the postpartum intrauterine infections（χ^2=16.397,28.669,37.036,P〈0.05）.Among the 191 patients with postpartum intrauterine infections,the incidence rates of fever and unclear lochia were 83.2%and 67.5%,respectively.The pathogens were detected in the submitted specimens of 162 of 191 pregnant women with intrauterine infections,with the detection rate 84.8%.Totally 209 strains of pathogens were isolated,of which 99（47.4%）were gram-negative bacteria,69（33.0%）were gram-positive bacteria,and 41（19.6%）were fungi;Escherichia coli,Staphylococcus epidermidis and Candida albicans were dominant among the pathogens,accounting for 26.8%,18.2%and 16.3%,respectively.CONCLUSION The pregnant women with postpartum intrauterine infections show certain characteristics in clinical manifestations,related factors and distribution of pathogens.It is necessary for the clinicians to p

关 键 词：产后宫内感染 临床特征 病原菌分布 

分 类 号：R719[医药卫生—妇产科学]