胎龄小于34周血培养阴性晚发型败血症早产儿结局及其影响因素分析  

Clinical analysis of outcome of premature infants less than 34 gestational weeks with culture-negative late-onset sepsis

作　　者：赵倩[1] 程紫梅 赵育弘 王杨[1] ZHAO Qian;CHENG Zimei;ZHAO Yuhong(Department of Pediatrics,the First Affiliated Hospital of Anhui Medical University,Hefei 230022,China)

机构地区：[1]安徽医科大学第一附属医院儿科,合肥230022

出　　处：《安徽医学》2020年第10期1123-1127,共5页Anhui Medical Journal

基　　金：安徽省科技厅公益技术应用研究联动计划项目(项目编号:1704f0804018);安徽省卫生计生适宜技术推广项目(项目编号:2016-RK01)。

摘　　要：目的分析胎龄小于34周早产儿血培养阴性晚发型败血症(LOS)患儿的临床结局与危险因素。方法回顾性分析安徽医科大学第一附属医院2015年5月至2019年4月胎龄小于34周诊断为血培养阴性LOS患儿的临床资料,按照临床转归分为治愈组和不良结局组,分析两组患儿出院时临床结局及预后不良患儿的危险因素。结果共纳入159例患儿,存活率为93.71%(149/159),不良结局发生率为38.99%(62/159)。62例不良结局患儿中,死亡10例,其余严重并发症包括Ⅱ期以上坏死性小肠结肠炎、Ⅲ期及以上早产儿视网膜病、Ⅲ~Ⅳ度脑室内出血、脑室周围白质软化、支气管肺发育不良。不良结局组患儿中,男性、母乳喂养时间<1/2住院日、机械通气>1周、重度呼吸窘迫综合征、使用血管活性药物、抗生素使用>3周的比例均高于治愈组,差异有统计学意义(P<0.05);不良结局组患儿胎龄、出生体质量均低于治愈组(P<0.05);不良结局组患儿总用氧时长、静脉营养时间、NICU住院时间均高于治愈组(P<0.05)。多因素分析显示,母乳喂养时间<1/2住院日、机械通气时间>1周、住院期间抗生素使用总时间>3周是血培养阴性LOS患儿出院时不良结局的独立危险因素。结论提高母乳喂养率、减少机械通气时间、规范使用抗生素可能改善血培养阴性LOS患儿临床结局。Objective To analyze the clinical outcome and risk factors of culture-negative LOS in premature infants with gestational age less than 34 weeks.Methods A retrospective analysis from May 2015 to April 2019 in our hospital was performed on gestational age less than 34 weeks of diagnosis of children with culture-negative LOS clinical data.They were divided into the cure group and the adverse outcome group according to clinical outcome.Then the clinical outcome and risk factors of poor prognosis at discharge were analyzed.Results A total of 159 children were included,with a survival rate of 93.71%(149/159)and an incidence of adverse outcomes of 38.99%(62/159).Among the 62 children with adverse outcomes,10 died,and the remaining serious complications included NEC above stage Ⅱ,stage Ⅲ or above ROP,stage Ⅲ-Ⅳ IVH,PVL,and BPD.The proportion of male children in adverse outcome group,breast-feeding time<1/2 hospital stay,mechanical ventilation>1 week,severe RDS,use of vasoactive drugs,and total antibiotic use time>3 weeks during hospitalization were all higher than those in cure group with statistically significant differences(P<0.05).The gestational age and birth weight of adverse outcome group were lower than that of cure group(P<0.05).The total duration of oxygen use,intravenous nutrition and NICU hospitalization in adverse outcome group were all higher than those in cure group(P<0.05).Logistic regression analysis showed that breast-feeding time<1/2 hospital stay,mechanical ventilation time>1 week,and total antibiotic use time>3 weeks during hospitalization were independent risk factors for adverse outcome at discharge of children with culture-negative LOS.Conclusion Increasing the rate of breast feeding,reducing the mechanical ventilation time and reasonable use of antibiotics may improve culture-negative LOS in children with clinical outcome.

关 键 词：早产儿 晚发型败血症 血培养阴性败血症 危险因素 预后 

分 类 号：R722.6[医药卫生—儿科]