CAJ | 학술논문

目的探讨将抗菌药物使用策略,由临床风险评估策略转变为风险评估结合感染筛查及监测策略,对出生早期有呼吸困难的足月新生儿和晚期早产儿抗菌药物使用率及治疗结局的影响。方法采用队列研究方法,选择2009年7月至2013年6月在四川大学华西第二医院新生儿科住院治疗的1712例合并呼吸困难的新生儿为研究对象。按照住院时间将其分为：研究组(n =776,住院时间为2011年7月至2013年6月)及对照组(n=936,住院时间为2009年7月至2011年6月)。对照组新生儿仅按照风险评估结果进行抗菌药物治疗,而研究组则按照风险评估结合感染筛查及监测结果进行抗菌药物治疗。对两组患儿抗菌药物使用率、再入院率、平均住院日及感染相关不良事件等进行统计学分析。两组患儿入院时年龄及性别构成比比较,差异均无统计学意义(P >0.05)。本研究遵循的程序符合四川大学华西第二医院人体试验委员会制定的伦理学标准,得到该委员会批准,分组征得患儿家属知情同意,并与家属签署临床研究知情同意书。结果两组均无死亡病例。①研究组抗菌药物使用率较对照组显著降低,且差异有统计学意义(P <0.01)。②两组患儿再入院率及平均住院日比较,差异均无统计学意义(P >0.05)。③两组患儿医院获得性感染、感染性肺炎、败血症、坏死性小肠结肠炎等与感染相关的不良事件发生率比较,差异亦均无统计学意义(P >0.05)。结论根据风险评估结合感染筛查及监测结果制定抗菌药物使用策略,可明显降低出生早期有呼吸困难足月新生儿和晚期早产儿的抗菌药物使用率,且不会对患儿产生不良影响。
목적탐토장항균약물사용책략,유림상풍험평고책략전변위풍험평고결합감염사사급감측책략,대출생조기유호흡곤난적족월신생인화만기조산인항균약물사용솔급치료결국적영향。방법채용대렬연구방법,선택2009년7월지2013년6월재사천대학화서제이의원신생인과주원치료적1712례합병호흡곤난적신생인위연구대상。안조주원시간장기분위：연구조(n =776,주원시간위2011년7월지2013년6월)급대조조(n=936,주원시간위2009년7월지2011년6월)。대조조신생인부안조풍험평고결과진행항균약물치료,이연구조칙안조풍험평고결합감염사사급감측결과진행항균약물치료。대량조환인항균약물사용솔、재입원솔、평균주원일급감염상관불량사건등진행통계학분석。량조환인입원시년령급성별구성비비교,차이균무통계학의의(P >0.05)。본연구준순적정서부합사천대학화서제이의원인체시험위원회제정적윤리학표준,득도해위원회비준,분조정득환인가속지정동의,병여가속첨서림상연구지정동의서。결과량조균무사망병례。①연구조항균약물사용솔교대조조현저강저,차차이유통계학의의(P <0.01)。②량조환인재입원솔급평균주원일비교,차이균무통계학의의(P >0.05)。③량조환인의원획득성감염、감염성폐염、패혈증、배사성소장결장염등여감염상관적불량사건발생솔비교,차이역균무통계학의의(P >0.05)。결론근거풍험평고결합감염사사급감측결과제정항균약물사용책략,가명현강저출생조기유호흡곤난족월신생인화만기조산인적항균약물사용솔,차불회대환인산생불량영향。
Objective To observe the antibiotic use rate and outcomes of full term and late preterm newborn infants complicated with dyspnea who were managed with two different antibiotics treatment strategies,namely,the clinical risk factors based antibiotic treatment strategy and combination antibiotic treatment strategy that is based on clinical risk factors,infection screening,and monitoring.Methods A cohort study was made with 1 712 newborn infants complicated with dyspnea signs who hospitalized in neonatal ward in West China Second University Hospital,Sichuan University from July 2009 to June 2013. According to hospitalization time periods,they were divided into study group of 776 cases(from July 201 1 to June 2013)and control group of 936 cases(from July 2009 to June 201 1).The control group adopted the clinical risk factors based antibiotic treatment strategy and the study group received a combination antibiotic treatment strategy based on clinical risk factors,infection screening,and monitoring.Antibiotic use rate, readmission rate,average hospitalization days and infection related adverse events of two groups were statistically analyzed.The age on admission and constituent ratio of gender between two groups had no statistically significant differences(P >0.05).The study protocol was approved by the Ethical Review Board of Investigation in Human Being of West China Second University Hospital,Sichuan University.Informed consent was obtained from the parents of each participant.Results There were no death case in two groups.①The antibiotic use rate of study group was significantly lower than that of control group,and the <br> difference was statistically significant (P < 0.01 ).② There were no statistically significant differences between two groups in readmission rate and average hospitalization days (P > 0.05 ).③ There were no statistically significant differences between two groups in incidence rate of infection related adverse events, such as acquired character infection in hospital,bacterial pneumonia,septicemia and necrotizing enterocolitis (P > 0.05 ).Conclusions The combination antibiotic treatment strategy based on clinical risk factors, infection screening,and monitoring can reduce antibiotic use rate for full term and late preterm newborn infants with dyspnea,and have no harmful effects on them.