优化抗生素管理对胎龄小于32周早产儿近期临床结局的影响  

Effect of an optimized antibiotic management on the short-term clinical outcome of preterm infants born with gestational age of<32 weeks

作　　者：薛瑞瑞 李向红[1] 李亮亮[1] 尹向云[1] 锡洪敏[1] 杨萍[1] 马丽丽[1] Xue Ruirui;Li Xianghong;Li Liangliang;Yin Xiangyun;Xi Hongmin;Yang Ping;Ma Lili(Department of Neonatology,the Affiliated Hospital of Qingdao University,Qingdao 266555,China)

机构地区：[1]青岛大学附属医院新生儿科,山东青岛266555

出　　处：《临床荟萃》2023年第8期706-713,共8页Clinical Focus

基　　金：山东省医药卫生科技发展项目维生素D干预治疗新生鼠高氧肺损伤的实验研究(2016WS0278)。

摘　　要：目的回顾性分析胎龄小于32周早产儿的临床资料,探讨优化抗生素管理对早产儿近期临床结局的影响。方法收集2017年1月1日至2018年6月30日、2019年1月1日至2020年12月31日于青岛大学附属医院新生儿监护室住院治疗的胎龄小于32周早产儿的临床资料。优化抗生素管理于2019年1月开始实施,将上述临床资料分为两组:优化前组158例(2017年1月1日至2018年6月30日);优化组156例(2019年1月1日至2020年12月31日),回顾性分析两组患儿的临床资料。结果与优化前组相比,优化组在早期抗生素使用时间(6 d比10 d)、抗生素使用总时间(11 d比16 d)、肠外营养时间(18 d比29.5 d)方面均明显缩短(P<0.01),早产儿视网膜病变(retinopathy of prematurity,ROP)的发生率明显降低(7.69%vs 15.82%,P<0.05);Logistic回归分析显示优化抗生素管理与近期不良结局无明显关联(P>0.05),抗生素使用时间延长、血培养阳性及机械通气是近期不良结局的危险因素。结论优化抗生素管理,缩短早产儿不必要的抗生素暴露,可减少肠外营养时间,降低ROP发生率,且不增加近期临床不良结局。延长抗生素使用时间增加近期临床不良结局。Objective To explore the effect of an optimized antibiotic management on the short-term clinical outcome of preterm infants born with gestational age of<32 weeks by retrospectively analyzing their clinical data.Methods Clinical data were retrospectively collected from preterm infants born with gestational age of<32 weeks who were admitted to the Neonatal Intensive Care Unit of the Affiliated Hospital of Qingdao University from January 1,2017 to June 30,2018 and from January 1,2019 to December 31,2020.The optimized antibiotic strategy was implemented since January 1,2019.Included preterm infants were divided into two groups,including pre-optimization group(January 1,2017 to June 30,2018,n=158)and optimization group(January 1,2019 to December 31,2020,n=156).The clinical data of preterm infants were compared between groups.Results Compared with the pre-optimization group,the duration of antibiotic use in the early postnatal period(6 d vs 10 d),the total duration of antibiotic use during hospitalization(11 d vs 16 d),and the duration of parenteral nutrition(18 d vs 29.5 d)in the optimization group were significantly shortened(P<0.01).The incidence rate of retinopathy of prematurity(ROP)in the optimization group was significantly lower than that in the pre-optimization group(7.69%vs 15.82%,P<0.05).The multivariate logistic regression analysis revealed that optimized antibiotic management was not significantly correlated with short-term adverse outcomes(P>0.05).Prolonged antibiotic use,positive blood culture and mechanical ventilation were risk factors for short-term adverse clinical outcome.Conclusion Shortening unnecessary antibiotic exposure in preterm infants can reduce the duration of parenteral nutrition and the incidence of ROP without increasing short-term adverse clinical outcomes.Prolonged antibiotic use increases the risk of adverse clinical outcome.

关 键 词：婴儿 早产 抗生素管理 不良结局 

分 类 号：R722[医药卫生—儿科]