新生儿败血症患儿母亲围生期感染因素及其临床症状和体征分析

Perinatal Risk Factors and Clinical Characters of Neonatal Sepsis

目的分析新生儿败血症患儿母亲围生期感染因素和其临床症状及体征,以正确识别感染早期症状,提高疾病救治水平。方法采用病例对照研究,选择2007年1月—2012年1月首都医科大学附属北京妇产医院新生儿重症监护病房(NICU)住院患儿240例。根据是否合并败血症分为败血症组120例和非败血症组120例,收集两组母亲围生期感染因素,患儿临床症状、体征,应用单因素和多因素Logistic回归分析进行比较。结果败血症组与非败血症组母亲孕期或产时发热、白细胞计数(WBC)及中性粒细胞分数升高、C反应蛋白(CRP)升高、产道特殊细菌定植、绒毛膜羊膜炎或子宫内膜炎、胎膜早破>18 h、羊水胎粪污染的检出率比较,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,母亲孕期或产时发热、WBC及中性粒细胞分数升高、CRP升高、产道特殊细菌定植、绒毛膜羊膜炎或子宫内膜炎、胎膜早破>18 h、羊水胎粪污染与败血症的发生有回归关系。败血症组与非败血症组患儿精神反应差、高血糖、循环不良、发热、喂养不耐受、呼吸窘迫、心动过速、易激惹、休克早期症状的检出率比较,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,精神反应差、高血糖、循环不良、病理性黄疸、呼吸窘迫、心动过速与败血症的发生有回归关系。结论多种母亲围生期感染因素和患儿临床症状及体征与新生儿败血症的发生相关。认真评估新生儿母亲围生期感染高危因素并识别患儿感染早期临床症状,采取积极有效的感染防控及临床干预措施,对改善患儿预后有一定意义。

Objective To correctly identify early symptoms of infection and improve the standards of medical care through analyzing perinatal risk factors and clinical manifestations of neonatal sepsis.Methods Case-control study was used.240 infants admitted to the Department of NICU of Beijing Obsterics and Gynecology Hospital from January 2007 to January 2012 were selected.The infants were divided into sepsis group and non-sepsis group with each group 120 cases.The perinatal risk factors and clinical symptoms were collected.Single factor and multi-factor regression analysis were performed.Results Between the sepsis group and non-sepsis group,fever during pregnancy or childbirth,abnormally high numbers of WBC or neutrophils,high level of C-reactive protein,birth canal special bacteria set point or secretion culture(+),chorioamnionitis,premature rupture of membranes and amniotic fluid contamination showed statistically significant differences(P < 0.05).Multi-factor regression analysis showed that fever during pregnancy or childbirth,abnormally high numbers of WBC or neutrophils,high level of C-reactive protein,birth canal special bacteria set point,chorioamnionitis,premature rupture of membranes and amniotic fluid contamination had regression relationship with sepsis.Infants from sepsis group and non-sepsis group showed statistically significant differences in mental reaction,abnormal blood sugar,poor circulation,abnormal body temperature,feeding intolerance,respiratory distress syndrome,tachycardia,irritability and early symptoms of shock(P < 0.05).Single factor regression analysis showed that mental reaction,abnormal blood sugar,poor circulation,pathological jaundice,respiratory distress syndrome and tachycardia had regression relationship with sepsis.Conclusion A careful assessment of the mothers' perinatal infection risk factors and identification of early clinical symptoms of sepsis may help us to take positive prevention and effective clinical interventions.It will also improve the prognosis of infants.