【摘要】：目的:明確本中心早期新生兒感染的高危因素,為其臨床管理提供理論依據(jù)。方法:收集2013年1月至2015年12月吉林大學(xué)第一醫(yī)院新生兒科生后3天內(nèi)合并感染(包括新生兒感染、新生兒敗血癥、化膿性腦膜炎)的441例新生兒作為病例組,并按1:1比例在同期住院生后3天內(nèi)無感染同性別及胎齡的新生兒中隨機(jī)抽取441例作為對(duì)照組。根據(jù)既往文獻(xiàn)資料中早期新生兒感染(early onset neonatal infection,EONI)的影響因素設(shè)計(jì)成調(diào)查表對(duì)既往病例進(jìn)行信息采集,內(nèi)容包括與EONI相關(guān)的孕母史、新生兒出生時(shí)及生后一般情況。應(yīng)用SPSS21.0軟件對(duì)EONI相關(guān)因素進(jìn)行單因素及多因素統(tǒng)計(jì)分析,明確EONI的高危因素。結(jié)果:(1)一般信息:441對(duì)新生兒,男性246對(duì)(55.8%),女性195對(duì)(44.2%),病例組胎齡34.19(31~38)周,對(duì)照組胎齡34.20(31~38)周。病例組中新生兒感染335例(76.0%,335/441),化膿性腦膜炎5例(1.1%,5/441),新生兒敗血癥101例(22.9%,101/441),其中血培養(yǎng)陽性40例(39.6%,40/101),病原體種類繁多,革蘭氏陽性葡萄球菌18例(45%,18/40),革蘭氏陰性桿菌13例(32.5%,13/40),革蘭氏陽性鏈球菌5例(12.5%,5/40),革蘭氏陽性桿菌3例(7.5%,3/40),白假絲酵母菌1例(2.5%,1/40),常見致病菌有:大腸埃希菌7例(17.5%,7/40)、金黃色葡萄球菌5例(12.5%,5/40)、表皮葡萄球菌3例(7.5%,3/40)、人葡萄球菌人亞種3例(7.5%,3/40)。(2)單因素分析結(jié)果:胎膜早破(Premature rupture of membranes,PROM)18h、羊水糞染、孕母產(chǎn)前發(fā)熱、產(chǎn)前應(yīng)用抗生素、極低出生體重兒(very low birth weight,VLBW)、生后窒息、生后3天內(nèi)發(fā)熱、新生兒出血性疾病、生后24小時(shí)內(nèi)白細(xì)胞計(jì)數(shù)異常(5.0×109/L或25×109/L)及血小板計(jì)數(shù)降低(150×109/L)是EONI的相關(guān)危險(xiǎn)因素。(3)多因素回歸分析:PROM18h、羊水糞染、VLBW、孕母產(chǎn)前發(fā)熱、生后3天內(nèi)發(fā)熱、生后24小時(shí)內(nèi)白細(xì)胞計(jì)數(shù)異常(5.0×109/L或25×109/L)及血小板計(jì)數(shù)降低(150×109/L)是EONI的獨(dú)立危險(xiǎn)因素。結(jié)論:(1)本中心EONI的血培養(yǎng)陽性率低,病原體種類繁多,以革蘭氏陽性葡萄球菌和革蘭氏陰性桿菌為主,常見致病病原菌包括:大腸埃希菌、金黃色葡萄球菌、表皮葡萄球菌、人葡萄球菌人亞種。(2)PROM18h、羊水糞染、孕母產(chǎn)前發(fā)熱、產(chǎn)前應(yīng)用抗生素、VLBW、生后3天內(nèi)發(fā)熱、新生兒出血性疾病、生后24小時(shí)內(nèi)白細(xì)胞計(jì)數(shù)異常及血小板計(jì)數(shù)降低是EONI的相關(guān)危險(xiǎn)因素。(3)PROM18h、羊水糞染、VLBW、孕母產(chǎn)前發(fā)熱、生后發(fā)熱、生后24小時(shí)內(nèi)白細(xì)胞計(jì)數(shù)異常及血小板計(jì)數(shù)降低是EONI的獨(dú)立危險(xiǎn)因素。
[Abstract]:Objective: to identify the high risk factors of early neonatal infection in our center and provide theoretical basis for clinical management. Methods: from January 2013 to December 2015, 441 newborns with neonatal infection (including neonatal infection, neonatal septicemia, suppurative meningitis) in the first Hospital of Jilin University were collected as the case group. At 1:1, 441 newborns of the same sex and gestational age were randomly selected as control group. According to the influencing factors of early neonatal infection with (early onset neonatal infection,EONI in the past literature, the information of past cases was collected by questionnaire, including the maternal history related to EONI, the general situation of newborn at birth and postnatal. Univariate and multivariate statistical analysis of EONI related factors was carried out with SPSS21.0 software to identify the high risk factors of EONI. Results: (1) General information: 441 pairs of newborns, 246 pairs of males (55.8%) and 195 pairs of females (44.2%), the gestational age of the case group was 34.19 (31 / 38) weeks, and that of the control group was 34.20 (31 / 38) weeks. There were 335 cases of neonatal infection (76.0% 335% 441), 5 cases of suppurative meningitis (1.1% / 441), 101 cases of neonatal septicemia (22.9% / 441), 40 cases of positive blood culture (39.6% 40 / 101), and a variety of pathogens. There were 18 Gram-positive staphylococci, 13 Gram-negative bacilli, 5 Gram-positive streptococcus, 3 Gram-positive bacilli, 3 Gram-positive bacilli, 1 Saccharomyces albicans (2.555 / 40), 7 Escherichia coli, 17.575 / 40. There were 5 cases of staphylococcus (12.5%), 3 cases of Staphylococcus epidermidis (7.5%), 3 cases of human staphylococcus human subspecies (7.5% 40). (2). The results of univariate analysis were as follows: premature rupture of membranes, (Premature rupture of membranes,PROM, 18 h, feces stained with amniotic fluid. Prenatal fever, prenatal antibiotics, very low birth weight (very low birth weight,VLBW), postnatal asphyxia, fever within 3 days of birth, neonatal hemorrhagic disease, Abnormal white blood cell count (5.0 脳 10 9 / L or 25 脳 10 9 / L) and decreased platelet count (150 脳 10 9 / L) in 24 hours after birth were related risk factors of EONI. (3) Multivariate regression analysis: PROM18h, meconium staining, prenatal fever in pregnant women with VLBW, fever within 3 days after birth. Abnormal leukocyte count (5.0 脳 109 / L or 25 脳 109 / L) and decreased platelet count (150 脳 109 / L) were independent risk factors for EONI. Conclusion: (1) the positive rate of blood culture of EONI in our center is low, and there are many kinds of pathogens, mainly Gram-positive Staphylococcus and Gram-negative bacilli. The common pathogenic bacteria include Escherichia coli, Staphylococcus aureus, Staphylococcus epidermidis, and Staphylococcus epidermidis. Human staphylococcus human subspecies. (2) feces stained with PROM18h, amniotic fluid, prenatal febrile pregnancy, antepartum application of antibiotics, fever within 3 days after birth of VLBW, hemorrhagic disease of newborn, Abnormal white blood cell count and decreased platelet count within 24 hours after birth were related risk factors of EONI. (3) PROM18h, amniotic fluid faecal staining, prenatal fever of VLBW, pregnant mother, postnatal fever, Abnormal leukocyte count and decreased platelet count within 24 hours after birth were independent risk factors for EONI.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R722.13

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 陳梅芳;;極低出生體重兒83例臨床分析[J];中外醫(yī)學(xué)研究;2016年06期

2 王瑩超;陸文香;周莉靖;;新生兒無乳鏈球菌感染的危險(xiǎn)因素及藥敏分析[J];國際檢驗(yàn)醫(yī)學(xué)雜志;2015年08期

3 張志強(qiáng);鐘繼生;陳翔;林小兵;;圍產(chǎn)期孕婦GBS感染、藥敏分析及對(duì)妊娠結(jié)局的影響[J];臨床醫(yī)學(xué)工程;2015年04期

4 莫志衛(wèi);;羊水污染、宮內(nèi)感染與新生兒窒息的相關(guān)性研究[J];臨床醫(yī)學(xué)工程;2015年03期

5 羅智花;王楊;王t t ;;新生兒血小板減少癥126例臨床分析[J];安徽醫(yī)藥;2015年01期

6 郝殿晉;李亞卓;孫鑫;李洪臣;張秀軍;;不同細(xì)胞因子和蛋白與妊娠期高血壓綜合征相關(guān)性的臨床研究[J];檢驗(yàn)醫(yī)學(xué);2014年08期

7 王少蕾;吳開鋒;劉丹;;足月選擇性剖宮產(chǎn)產(chǎn)前激素應(yīng)用對(duì)母兒影響的研究[J];中國傷殘醫(yī)學(xué);2014年07期

8 陳悅?cè)?王志華;姜文英;吳雅楓;;胎膜早破亞臨床絨毛膜羊膜炎與早發(fā)型新生兒敗血癥的關(guān)系[J];浙江預(yù)防醫(yī)學(xué);2014年04期

9 吳俊超;梁娣;楊靜清;劉軍民;李玉萍;劉永兵;黃靜;楊國華;;NICU患兒醫(yī)院感染危險(xiǎn)因素分析及對(duì)策[J];中華醫(yī)院感染學(xué)雜志;2013年23期

10 李夏影;;羊水補(bǔ)充療法在妊娠晚期胎膜早破中的臨床應(yīng)用分析[J];當(dāng)代醫(yī)學(xué);2013年17期

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