极低与超低出生体重早产儿发生真菌败血症的影响因素  

Clinical Analysis of Influencing Factors of Fungal Septicemia in Extremely Low Birth Weight Preterm Infants

作　　者：李笑[1] 吴运芹[1] 李贵南[1] 常淑婷[1] 马金霞[1] LI Xiao;WU Yun-qin;LI Gui-nan(Department of Neonatology,Hunan Children's Hospital,Changsha Hunan 410007)

机构地区：[1]湖南省儿童医院新生儿科,湖南长沙410007

出　　处：《医学临床研究》2022年第10期1539-1541,1545,共4页Journal of Clinical Research

摘　　要：【目的】探讨极低与超低出生体重早产儿发生真菌败血症的影响因素。【方法】选择2016年1月至2020年12月湖南省儿童医院早产儿重症监护病房收治的181例极低与超低出生体重早产儿,根据血培养真菌检测结果将患儿分为观察组(真菌血培养阳性,n=21)及对照组(真菌血培养阴性,n=160)。收集两组新生儿的临床资料,采用Logistic回归分析真菌败血症的相关影响因素,并分析菌株培养及药敏结果,记录患儿用药情况及转归。【结果】两组患儿在男性、阴道分娩、出生窒息、胎膜早破、使用肺表面活性物质(PS)、合并慢性肺疾病方面比较,差异无统计学意义(P>0.05);两组患儿在联合使用抗生素时间≥7 d、肠外营养使用时间≥14 d、PICC留置时间≥14 d、有创机械通气时间≥7 d方面比较,差异有统计学意义(P<0.05)。Logistic回归分析显示:联合使用抗生素时间≥7 d、PICC留置时间≥14 d、有创机械通气时间≥7 d是影响极低与超低出生体重早产儿发生真菌败血症的独立危险因素(P<0.05)。【结论】极低与超低出生体重早产儿真菌败血症多为院内感染,合理使用抗生素、加强PICC置管的管理及缩短有创机械通气时间对降低真菌败血症的发生率具有重要意义。【Objective】To investigate the influencing factors of fungal septicemia in extremely low/ultra-low birth weight premature infants.【Methods】A total of 181 cases of extremely low/ultra-low birth weight preterm infants admitted to the preterm intensive care unit of Hunan Children's Hospital from January 2016 to December 2020 were selected and divided into the observation group(with positive blood fungal culture,n=21)and the control group(with negative blood fungal culture,n=160)according to the occurrence of positive blood fungal culture.The clinical data of the two groups were collected and compared retrospectively.Logistic regression was used to analyze the related influencing factors of fungal sepsis.The results of bacterial strain culture and drug sensitivity were analyzed,while the drug use and outcome of the children were recorded.【Results】There were no significant differences between the two groups in terms of gender,vaginal delivery,birth asphyxia,premature rupture of membranes,use of pulmonary surfactant(PS)and complication with chronic lung disease(P>0.05).There were significant differences in the combined use of antibiotics for≥7 days,parenteral nutrition for≥14 days,PICC indwelling for≥14 days,and invasive mechanical ventilation for≥7 days(P<0.05).Logistic regression analysis showed that the combined use of antibiotics≥7 days,PICC indwelling≥14 days,and invasive mechanical ventilation≥7 days were independent risk factors for fungal sepsis in extremely low and ultra-low birth weight preterm infants(P<0.05).Parenteral nutrition≥14 days was a non-independent risk factor for fungal sepsis in extremely low and ultra-low birth weight preterm infants(P>0.05).【Conclusion】Fungal sepsis in extremely low and ultra-low birth weight preterm infants is mostly nosocomial infection.Rational use of antibiotics,strengthening the management of PICC and shortening the duration of invasive mechanical ventilation can reduce the infection rate of fungal sepsis.

关 键 词：婴儿 极低出生体重 婴儿 超低出生体重 脓毒症/微生物学 

分 类 号：R72[医药卫生—儿科]