经阴试产转剖宫后产褥期感染因素分析  

Analysis of the Relative Factors in Puerperal Infection of the Parturient Who Transferred to Caesarean Section by Vaginal Delivery

作　　者：于莎[1] 孙梦竹[1] 刘艳飞[1] 赵蕾[1] 张宁[1] 张琦[1] YU Sha;SUN Mengzhu;LIU Yanfei;ZHAO Lei;ZHANG Ning;ZHANG Qi(Department of Obstetrics and Gynecology,Affiliated Hospital of Qingdao University,Qingdao Shandong 266500,China)

机构地区：[1]青岛大学附属医院产科,山东青岛266500

出　　处：《临床研究》2022年第6期13-16,共4页Clinical Research

基　　金：山东省医药卫生科技发展计划项目(2018WS380)。

摘　　要：目的分析经阴试产中转剖宫产分娩产妇手术后发生产褥期感染的原因、致病微生物分布及其对药物的耐药性。方法本研究为回顾性研究,选取青岛大学附属医院2014年1月至2019年1月间收治的经阴分娩失败中转剖宫产分娩产妇987例收集术前、术后发生产褥期感染118例换着的临床资料,对产褥期感染产妇的高危因素进行分析;对术前即出现体温升高的患者,术中取羊水培养,术后出现高热寒颤者同时进行血培养;对致病微生物耐药性和细菌培养结果进行分析。结果产褥感染与胎膜早破及胎膜破裂时间(超过24 h)、羊水Ⅲ度污染、转剖宫产时宫口扩张大小、经阴试产时间、产前贫血、产后出血等高危因素相关。118例经阴试产转剖宫产分娩手术后发生产褥期感染的患者,共分离出126株病原菌,致病微生物主要来源于肠道,首位致病菌为大肠杆菌,次位为粪肠球菌,其中革兰氏阳性菌占56.35%,以粪肠球菌及表皮葡萄球菌为主;革兰氏阴性菌占42.06%,以肺炎克雷伯菌和大肠埃希菌为主。主要革兰阴性菌中,大肠埃希菌对头孢唑啉、哌拉西林、氨苄西林的耐药率较高;主要革兰阳性菌中,粪肠球菌对四环素、红霉素、克林霉素的耐药率较高。结论增强孕妇保健意识,控制孕期体重,合理评估经阴分娩条件,提高产科质量,降低经阴分娩转剖宫产的发生率,规范抗生素的应用,加强院感管理可降低阴道分娩失败转剖宫产手术的产褥感染的发生。临床可根据产褥感染病原微生物的种类及其耐药性等特点选用抗菌药物,保障产妇健康。Objective To investigate the influencing factors of puerperal infection of parturient after transferring to caesarean section by vaginal delivery and the distribution of pathogenic bacteria and their resistance to antibiotics. Methods A total of 987 women who failed to deliver by vagina and transferred to caesarean were selected from January 2014 to January 2019 and 118 cases of puerperal infection were collected to analyze the high-risk factors of maternal puerperium infection;Amniotic fluid was taken from puerperal infection patients during operation to cultivate for patients with elevated body temperature immediately before surgery. At the same time, blood culture was carried out for those with high fever and shiver. The drug resistance of the pathogenic microorganisms and the bacterial culture results were analyzed. Results The puerperal infection was related to premature rupture of membranes, the time of rupture of membrane(more than 24 h), degree Ⅲ pollution of amniotic fluid, the degree of dilatation of uterine orifice during cesarean section, the time of vaginal delivery, prenatal anemia, postpartum hemorrhage. A total of 126 pathogens were isolated from 118 patients with puerperal infection after cesarean section The microbe of puerperal infection mainly comes from the intestines and the main infection bacterias are Escherichia coli and Enterococcus faecalis. Gram-positive bacteria accounts for 56.35%, for which Enterococcus faecalis and Staphylococcus epidermidis are the main bacterias. Gram-negative bacteria accounts for 42.06%, for which Escherichia coli and Klebsiella pneumoniae are the main bacterias. The resistance rate of Escherichia coli in the main Gram-negative bacterias to ampicillin, piperacillin and cefazolin was higher and among the main Gram-positive bacteria, Enterococcus S. faecalis showed high resistance to tetracycline, erythromycin and clindamycin. Conclusion Strengthening the health care during pregnancy, treating pregnancy complications, improving the quality of Obstetrics, streng

关 键 词：经阴试产中转剖宫产分娩 产褥期感染 耐药性 

分 类 号：R715.3[医药卫生—妇产科学]