极低出生体重儿院内感染败血症的危险因素分析  

Analysis of risk factors of nosocomial sepsis in very low birth weight infants

作　　者：刘晓丹 冀湧[1] 盖建芳[1] Liu Xiaodan;Ji Yong;Ge Jianfang(Department of Neonatal Intensive Care Center,Children’s Hospital of Shanxi,Taiyuan 030013,China)

机构地区：[1]山西省儿童医院新生儿重症监护中心,太原030013

出　　处：《中国实用医刊》2020年第14期25-28,共4页Chinese Journal of Practical Medicine

摘　　要：目的:探讨极低出生体重儿(VLBWI)院内感染败血症的危险因素,并针对性制定防治措施。方法:回顾性抽取2016年2月至2020年1月山西省儿童医院新生儿重症监护病房患儿3196例中院内感染败血症VLBWI 39例作为观察组,另选取同期无院内感染败血症VLBWI 81例作为对照组。分析院内感染败血症VLBWI占比及病原菌分布情况,应用Logistic回归分析院内感染败血症危险因素。结果:院内感染败血症VLBWI约占同期住院患儿的1.22%(39/3196),占新生儿败血症的19.90%(39/196);LBWI院内感染败血症发病时间为入院后3~36 d,主要表现为体重降低、拒乳、发热、反应迟钝、黄疸、消化系统症状等;主要病原菌为肺炎克雷伯菌(28.89%)、大肠埃希菌(17.78%)、葡萄球菌(17.78%);两组出生体重、中心静脉导管(PICC)留置时间、机械通气时间、全肠内喂养时间、住院时间比较,差异有统计学意义(P<0.05);经Logistic回归系数分析显示,出生体重≤1000g、PICC留置时间长、机械通气时间长、住院时间长是VLBWI院内感染败血症的独立危险因素(OR=4.205、5.101、1.094、1.590,P=0.001、0.001、0.018、0.001)。结论:VLBWI院内感染败血症与出生体重、PICC留置时间等多种因素有关,临床严格无菌操作、合理应用抗生素及预防性抗真菌治疗对降低其患病率具有重要意义。Objective To investigate the risk factors of nosocomial sepsis in very low birth weight infants(VLBWI),and to develop specific prevention and treatment measures.Methods Thirty-nine VLBWI with nosocomial sepsis from 3196 inpatients in Neonatal Intensive Care Unit of Children’s Hospital of Shanxi from February 2016 to January 2020 were retrospectively selected as the observation group,another 81 VLBWI without nosocomial sepsis during the same period were selected as the control group.The proportion of nosocomial sepsis VLBWI and the distribution of pathogens were analyzed,and Logistic regression analysis was used to analyze the risk factors of nosocomial sepsis.Results Nosocomial sepsis VLBWI accounted for approximately 1.22%(39/3196)of children hospitalized during the same period,and accounted for 19.90%(39/196)of neonatal sepsis;the onset time of nosocomial sepsis in LBWI was 3 to 36 days after admission,the main manifestations were decreased body weight,milk rejection,fever,sluggish response,jaundice,and digestive symptoms;the main pathogens were klebsiella pneumoniae(28.89%),escherichia coli(17.78%),staphylococcus(17.78%),there were significant differences in birth weight,peripherally inserted central catheters(PICC)indwelling time,ventilation time,total stomach feeding time,and hospital stay between the two groups(P<0.05);Logistic regression coefficient analysis showed that birth weight≤1000g,long PICC indwelling time,long ventilation time,and long hospital stay were independent risk factors for nosocomial sepsis in VLBWI(OR=4.205,5.101,1.094,1.590,P=0.001,0.001,0.018,0.001).Conclusions The nosocomial sepsis in VLBWI is related to many factors such as birth weight and PICC indwelling time,the strict clinical aseptic operation,rational application of antibiotics and preventive antifungal therapy are of great significance to reduce the prevalence of which.

关 键 词：败血症 极低出生体重儿 院内感染 肺炎克雷伯菌 大肠埃希菌 

分 类 号：R720.597[医药卫生—急诊医学]