104例新生儿败血症血液培养结果与临床特征分析及护理启示

Analysis of Blood Culture and Clinical Characters of 104 Cases of Neonatal Sepsis and Its Nursing Interventions

目的探讨新生儿败血症的易感因素、临床特征、菌种分布和耐药情况,以期确定败血症发生的危险因素和预测指标,为临床护理人员早期识别新生儿败血症,采取正确的处理措施提供依据。方法对104例新生儿败血症患儿根据其发病时间分为早发组(55例)和晚发组(49例),对其临床资料、病原菌以及药敏试验结果进行分析,同时探讨临床症状与血培养结果之间的关系。结果母亲发热、羊水胎便染色以及胎膜早破在败血症患儿发生率高于正常新生儿(P<0.05)。40份样本血液培养阳性,以革兰氏阴性杆菌为主(75.0%),包括肺炎克雷伯杆菌、铜绿假单胞杆菌和大肠埃希菌等。致病菌对青霉素、阿莫西林耐药严重,对环丙沙星、亚胺培南以及万古霉素敏感。败血症患儿嗜睡、喂养困难、黄疸和发绀发生率显著高于正常新生儿(P<0.05),其中嗜睡患儿血培养阳性率较高,在早发组败血症患儿中,发绀和惊厥症状的患儿血培养阳性率较高(P<0.05)。结论母亲发热、羊水胎便染色以及胎膜早破可能是新生儿发生败血症的危险因素,嗜睡、喂养困难、黄疸和发绀可能对败血症的发生具有预测作用;对于存在这些危险因素和临床症状的患儿,护理人员在工作中应该提高警惕,及时进行护理干预,减少发生败血症的风险。

Objective To explore risk factors of neonatal sepsis, to explore the relationship between clinical symptoms and blood culture results and to provide corresponding nurse interventions. Methods In the study, 104 neonates with clinical neonatal sepsis were divided into early onset neonatal sepsis group （n=55） and later onset neonatal sepsis group （n=49）. The baseline characters, blood culture results and clinical symptoms were analyzed, and the relationship between clinical symptoms and blood culture results were also studied. Results The incidence of maternal fever, amniotic fluid meconium and premature rupture of membrane were significantly higher in neonates with neonatal sepsis than in health neonates （P〈0.05）. There were 40 blood samples with positive blood culture and the main pathogenic organics were gram negative bacilli （75.0%）, including Klebsiella pneumoniae, Pseudomonas aeruginosa and Escherichia coil Pathogenic organics were resistant to penicillin, amoxicillin, while sensitive to ciprofloxacin, imipenem and vancomycin. The incidence of lethargy, inability to feed, cyanosis and jaundice were significantly higher in neonates with neonatal sepsis than in health neonates （P〈0.05）and lethargy was significantly associated with positive blood culture in both early and later onset neonatal sepsis. In early onset neonatal sepsis group, there was positive blood culture of cyanosis and convulsion. Conclusion Maternal fever, amniotic fluid meconium and premature rupture of membrane could be risk factors for neonatal sepsis. Lethargy, inability to feed, cyanosis and jaundice might have predictive value for neonatal sepsis, which may be helpful for nurses to get early identification and predict risk of neonatal sepsis in neonates, and to give proper nursing measurements.