本文選題：抗生素 + 院內(nèi)感染　； 參考：《吉林大學(xué)》2012年碩士論文

【摘要】：近年來，隨著新生兒救治水平的逐漸提高，早產(chǎn)兒的存活率明顯升高，而早產(chǎn)兒院內(nèi)感染則越來越受到人們的重視，感染性疾病已成為導(dǎo)致新生兒重癥監(jiān)護病房（neonatal intense care unit，NICU）中患兒死亡的最常見原因之一。早產(chǎn)兒是一個特殊群體，因其器官發(fā)育不成熟、機體免疫功能低下，接受各種侵襲性操作機會多、住院時間長等特點，使其院內(nèi)感染發(fā)病率高，對于早產(chǎn)兒是否應(yīng)預(yù)防性應(yīng)用抗生素越來越受到國內(nèi)外專家的關(guān)注。有學(xué)者認(rèn)為早產(chǎn)兒生后預(yù)防性應(yīng)用抗生素可以降低院內(nèi)感染的發(fā)生率，也有專家持不同意見。本文主要研究預(yù)防性應(yīng)用抗生素與早產(chǎn)兒院內(nèi)感染發(fā)病的關(guān)系，以及針對12項早產(chǎn)兒院內(nèi)感染的可疑危險因素進行分析，進一步明確預(yù)防性應(yīng)用抗生素是否對早產(chǎn)兒院內(nèi)感染有保護性作用，并明確早產(chǎn)兒院內(nèi)感染發(fā)病的危險因素，旨在對早產(chǎn)兒臨床合理應(yīng)用抗生素能起到一定的指導(dǎo)作用。本文采用回顧性收集病例資料，在2009年1月-2011年12月吉林大學(xué)第一醫(yī)院新生兒科收治的符合研究條件的早產(chǎn)兒中抽取409例，按照是否發(fā)生院內(nèi)感染將樣本分為2組，即感染組與非感染組，將生后48小時內(nèi)預(yù)防性應(yīng)用抗生素設(shè)為可疑保護因素，胎齡（gestational age，GA）、出生體重（birth weight，BW）、開奶時間、機械通氣（mechanical ventilation，MV）、外周置入中心靜脈導(dǎo)管（peripherallyInserted Central Catheter，PICC）、動脈置管、住院時間等視為可疑危險因素，應(yīng)用χ2檢驗及多因素非條件逐步Logistic回歸分析明確早產(chǎn)兒院內(nèi)感染的危險因素以及預(yù)防性應(yīng)用抗生素對早產(chǎn)兒院內(nèi)感染是否有保護作用。結(jié)果顯示：1．將2組中上述影響因素行單因素χ2檢驗，結(jié)果顯示：GA≤32w，BW≤1500g，開奶時間在生后5d以后，應(yīng)用MV，PICC，，動脈置管，住院時間大于2w以及預(yù)防性應(yīng)用抗生素均與院內(nèi)感染顯著相關(guān)（P值均＜0.01）；2．進一步logistic多因素回歸分析，顯示GA≤32w（P=0.031，OR=1.738）、BW≤1500g（P=0.032，OR=1.849）及住院時間大于2w（P=0.000，OR=6.446）為早產(chǎn)兒院內(nèi)感染的獨立危險因素，其中院內(nèi)感染的發(fā)生率隨GA及BW的增加而降低，預(yù)防性應(yīng)用抗生素并非院內(nèi)感染的保護因素（P=0.91，OR=1.029）；3．409例病例中，有191例發(fā)生院內(nèi)感染，院內(nèi)感染發(fā)生率為46.7%，其中以肺炎局首位；4．共培養(yǎng)出病原菌27株，細(xì)菌以肺炎克雷伯桿菌為主，真菌以白假絲酵母菌為主。結(jié)論：1．預(yù)防性應(yīng)用抗生素為并非院內(nèi)感染的保護因素；2．GA≤32w、BW≤1500g、開奶時間在生后5d以后、應(yīng)用MV、PICC、動脈置管、住院時間大于2w以及預(yù)防性應(yīng)用抗生素均為早產(chǎn)兒院內(nèi)感染的危險因素；3．GA≤32w、BW≤1500g及住院時間大于2w為早產(chǎn)兒院內(nèi)感染的獨立危險因素，院內(nèi)感染的發(fā)生率隨GA及BW的升高而降低；4．預(yù)防早產(chǎn)兒院內(nèi)感染的有效措施為加強早產(chǎn)兒綜合管理以及正確合理使用抗生素。
[Abstract]:In recent years, with the gradual improvement of the level of neonatal treatment, the survival rate of premature infants has increased significantly, while nosocomial infection of premature infants has been paid more and more attention. Infectious diseases have become one of the most common causes of death in neonatal intense care unit. Premature infants are a special group, because their organs are immature, their immune function is low, they have many opportunities to accept various invasive operations, and their hospital stay is long, so the incidence of nosocomial infection is high. More and more experts at home and abroad pay more and more attention to the prophylactic use of antibiotics for preterm infants. Some scholars believe that prophylactic use of antibiotics can reduce the incidence of nosocomial infection in preterm infants. The relationship between prophylactic use of antibiotics and nosocomial infection in premature infants was studied, and the suspicious risk factors of nosocomial infection in 12 premature infants were analyzed. To further determine whether prophylactic use of antibiotics has protective effect on nosocomial infection of premature infants and the risk factors of nosocomial infection of premature infants, the purpose of this study is to provide guidance for rational use of antibiotics in clinical practice of premature infants. From January 2009 to December 2011, 409 premature infants who were admitted to the Department of Neonatrics in the first Hospital of Jilin University were selected and divided into two groups according to whether or not nosocomial infection occurred. In the infection group and the non-infection group, prophylactic use of antibiotics within 48 hours after birth was regarded as a suspicious protective factor. Gestational age, birth weight, milk opening time, mechanical ventilation, peripheral placement of central venous catheter, peripheral catheter inserted into the central vein, catheterization, arterial catheterization. Hospital stay was regarded as a suspicious risk factor. 蠂 2 test and multivariate stepwise Logistic regression analysis were used to determine the risk factors of nosocomial infection of premature infants and whether prophylactic use of antibiotics had protective effect on nosocomial infection of preterm infants. The result is 1: 1. Univariate 蠂 2 test was performed on the above factors in the two groups. The results showed that the weight GA 鈮

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