新生儿坏死性小肠结肠炎病原菌与外科手术治疗效果分析  

Analysis of pathogenic bacteria and surgical treatment of neonatal necrotizing enterocolitis

作　　者：朱旭光[1] 朱君丽[1] 周丽霞[1] 段春胜[1] 李媛[1] ZHU Xu-guang;ZHU Jun-li;ZHOU Li-xia;DUAN Chun-sheng;LI Yuan(Xingtai People's Hospital,Xingtai,Hebei 054000,China)

机构地区：[1]邢台市人民医院小儿外科,河北邢台054000

出　　处：《中华医院感染学杂志》2020年第4期591-595,共5页Chinese Journal of Nosocomiology

基　　金：邢台市卫生医药科技攻关计划基金资助项目(2917833)。

摘　　要：目的探讨新生儿坏死性小肠结肠炎(Necrotizing enterocolitis of newborn,NEC)病原菌与外科手术治疗效果,为患儿临床治疗提供依据。方法选择2013年9月-2018年9月于邢台市人民医院手术治疗的NEC患儿95例,检测患儿粪便标本及血液标本病原菌情况,根据患儿手术时机分为早期手术组51例、晚期手术组44例,根据患儿具体情况选择实施肠切除-肠吻合术、肠造瘘或腹腔引流术,比较两组患儿手术治疗疗效及预后。结果95例患儿共分离病原菌73株,其中革兰阴性菌41株占56.16%,以肺炎克雷伯菌及大肠埃希菌为主;革兰阳性菌29株占39.73%,以表皮葡萄球菌和金黄色葡萄球菌为主;真菌3株占4.11%。肺炎克雷伯菌和大肠埃希菌对青霉素耐药率为100%,对左氧氟沙星耐药率<30%;表皮葡萄球菌和金黄色葡萄球菌对链霉素和利奈唑胺较敏感(耐药率<16%)。早期手术组患儿手术治疗临床疗效优于晚期手术组(P<0.05)。早期手术组患儿术后并发症发生率为7.84%(4/51)低于晚期手术组(P<0.05)。早期手术组治愈率为80.39%(41/51)高于晚期手术组(P<0.05)。结论新生儿坏死性小肠结肠炎患儿主要病原菌为革兰阴性菌,对于有手术指征的患儿,尽早进行手术能降低术后并发症的发生并提高治愈率。OBJECTIVE To investigate the pathogenic bacteria and the effect of surgical treatment in neonatal necrotizing enterocolitis,so as to provide basis for clinical treatment of newborn.METHODS Totally 95 children with NEC who were surgically treated at Xintai People’s Hospital from Sep.2013 to Sep.2018 were selected.The distribution of pathogenic bacteria in stool and blood samples was detected.According to the timing of surgery,they were divided into 51 cases in the early operation group and 44 cases in the late operation group were divided into two groups.According to the specific conditions of the children,intestinal resection-intestinal anastomosis,intestinal fistula or abdominal drainage were selected.The therapeutic effect andprognosis of the two groups were compared.RESULTS A total of 73 pathogenic bacteria were isolated from 95 children,of which 41 strains of Gram-negative bacteria accounted for 56.16%,mainly Klebsiella pneumoniae and Escherichia coli;29 strains of Gram-positive bacteria accounted for 39.73%,dominating by Staphylococcus epidermidis and Staphylococcus aureus;3 strains of fungi account for 4.11%.The resistance rate of K.pneumoniae and Escherichia coli to penicillin was 100%,to levofloxacin was less than 30%,and that of S.epidermidis and S.aureus to streptomycin and linezolid was less than 16%.The clinical efficacy of early operation group was significantly better than that in the late operation group(P<0.05).The postoperative complication rate was 7.84%(4/51)in the early operation group,significantly lower than that in the late operation group(P<0.05).The cure rate in the early operation group was 80.39%(41/51),significantly higher than that in thelate operation group(P<0.05).CONCLUSION The main pathogens in children with neonatal necrotizing enterocolitis were Gram-negative bacteria.For children with surgical indications,early surgery can reduce the incidence of surgical complications and improve the cure rate.

关 键 词：新生儿坏死性小肠结肠炎 病原菌 手术治疗 疗效 

分 类 号：R378[医药卫生—病原生物学]