中国小儿急救医学
中國小兒急救醫學
중국소인급구의학
CHINESE PEDIATRIC EMERGENCY MEDICINE
2013年
1期
62-65
,共4页
邵红梅%严建江%Salma B
邵紅梅%嚴建江%Salma B
소홍매%엄건강%Salma B
晚发感染%极低出生体重儿%危险因素
晚髮感染%極低齣生體重兒%危險因素
만발감염%겁저출생체중인%위험인소
Late onset infection%Very low birth weight infant%Risk factor
目的 调查加纳Korle-Bu教学医院NICU住院的极低出生体重儿(very low birth weight infant,VLBWI)晚发感染的发生率和病死率,并分析晚发感染的相关危险因素.方法 收集2011年11月至2012年4月加纳Korle-Bu教学医院NICU住院的所有VLBWI的临床及实验室资料,分析与晚发感染相关的资料[临床表现、血液和(或)脑脊液培养结果、生化指标等].晚发感染的定义为:出生7d后起病的新生儿感染.利用Logistic回归分析晚发感染相关危险因素.结果 244例VLBWI的存活率为61.9％ (151/244)；晚发感染的发生率为30.3％(74/244),病死率为32.3％ (21/65).最常见的感染病原体为肺炎克雷白杆菌,占晚发感染的38.5％(25/65),占晚发感染VLBWI死亡人数的47.6％(10/21)；其次的病原体是凝固酶阴性葡萄球菌,分别为16.9％ (11/65)和14.3％(3/21).Logistic回归分析显示,革兰阴性菌感染的相关危险因素为:出生时的气管插管、呼吸窘迫综合征、输血；而新生儿低血糖与革兰阳性菌感染密切相关；出生体重＜1 000 g,胎龄＜28周、机械通气、中心静脉置管与上述两种感染密切相关.结论 多因素导致VLBWI晚发感染的发生,加强VLBWI管理,改善NICU条件,加强医务人员的培训可能降低早产儿晚发感染的发生和死亡.
目的 調查加納Korle-Bu教學醫院NICU住院的極低齣生體重兒(very low birth weight infant,VLBWI)晚髮感染的髮生率和病死率,併分析晚髮感染的相關危險因素.方法 收集2011年11月至2012年4月加納Korle-Bu教學醫院NICU住院的所有VLBWI的臨床及實驗室資料,分析與晚髮感染相關的資料[臨床錶現、血液和(或)腦脊液培養結果、生化指標等].晚髮感染的定義為:齣生7d後起病的新生兒感染.利用Logistic迴歸分析晚髮感染相關危險因素.結果 244例VLBWI的存活率為61.9％ (151/244)；晚髮感染的髮生率為30.3％(74/244),病死率為32.3％ (21/65).最常見的感染病原體為肺炎剋雷白桿菌,佔晚髮感染的38.5％(25/65),佔晚髮感染VLBWI死亡人數的47.6％(10/21)；其次的病原體是凝固酶陰性葡萄毬菌,分彆為16.9％ (11/65)和14.3％(3/21).Logistic迴歸分析顯示,革蘭陰性菌感染的相關危險因素為:齣生時的氣管插管、呼吸窘迫綜閤徵、輸血；而新生兒低血糖與革蘭暘性菌感染密切相關；齣生體重＜1 000 g,胎齡＜28週、機械通氣、中心靜脈置管與上述兩種感染密切相關.結論 多因素導緻VLBWI晚髮感染的髮生,加彊VLBWI管理,改善NICU條件,加彊醫務人員的培訓可能降低早產兒晚髮感染的髮生和死亡.
목적 조사가납Korle-Bu교학의원NICU주원적겁저출생체중인(very low birth weight infant,VLBWI)만발감염적발생솔화병사솔,병분석만발감염적상관위험인소.방법 수집2011년11월지2012년4월가납Korle-Bu교학의원NICU주원적소유VLBWI적림상급실험실자료,분석여만발감염상관적자료[림상표현、혈액화(혹)뇌척액배양결과、생화지표등].만발감염적정의위:출생7d후기병적신생인감염.이용Logistic회귀분석만발감염상관위험인소.결과 244례VLBWI적존활솔위61.9％ (151/244)；만발감염적발생솔위30.3％(74/244),병사솔위32.3％ (21/65).최상견적감염병원체위폐염극뢰백간균,점만발감염적38.5％(25/65),점만발감염VLBWI사망인수적47.6％(10/21)；기차적병원체시응고매음성포도구균,분별위16.9％ (11/65)화14.3％(3/21).Logistic회귀분석현시,혁란음성균감염적상관위험인소위:출생시적기관삽관、호흡군박종합정、수혈；이신생인저혈당여혁란양성균감염밀절상관；출생체중＜1 000 g,태령＜28주、궤계통기、중심정맥치관여상술량충감염밀절상관.결론 다인소도치VLBWI만발감염적발생,가강VLBWI관리,개선NICU조건,가강의무인원적배훈가능강저조산인만발감염적발생화사망.
Objective To examine the incidence and mortality for late onset infection of very low birth weight infant(VLBWI) and associated risk factors in neonatal intensive care unit(NICU) of Korle-Bu teaching hospital in Ghana.Methods Data on all infants 1 500 g or below admitted to Korle-Bu teaching hospital NICU between Nov 2011 and Apr 2012 were analyzed for late onset infection,including:clinical information,positive blood or/and cerebrospinal fluid culture,biochemical data occurring after 7 days of life.Late onset infection was defined as clinical signs of infection starting more than 7 days after birth.The risk factors associated with late onset infection were investigated by Logistic regression.Results The overall survival of the 244 study infants was 61.9％ (151/244).The rate of late onset infection was 30.3％ (74/244).The mortality in those with late onset infection was 32.3％ (21/65).The most common infection organism was Klebsiella pneumoniae,accounting for 38.5％ (25/65) of infection and 47.6％ (10/21) of deaths in infants with infection,followed by coagulase-negative staphylocci,16.9％ (11/65) and 14.3 ％ (3/21),respectively.On logistic regression analysis,risk factors for Gram-negative infection were endotracheal intubation at birth,respiratory distress syndrome and blood transfusion.Hypoglycemia was associated with Gram-positive infection.Birth weight ＜ 1 000 g,gestational age ＜ 28 weeks,mechanical ventilation,central venous catherization were associated with both infection above.Conclusion Multifactor cause late onset infection in VLBWI.The supervision should be extended to decrease the incidence and mortality of the infection in NICU.
