新生儿留置胃管末端病原体临床监测与分析

Analysis of pathogens in culture of gavage tube endings in neonates

目的通过监测新生儿留置胃管末端病原体培养结果分析阳性率的相关因素。方法选择2011年5—8月入住复旦大学附属儿科医院新生儿重症监护病房留置胃管的患儿156例,对胃管末端进行细菌培养,并对培养结果进行相关因素分析。结果 156例留置胃管末端病原体培养的患儿中,阳性率为39.1%,其中培养病原体分别为鲍曼不动杆菌36例、凝固酶阴性葡萄球菌10例、阴沟肠杆菌5例、大肠埃希菌3例、金黄色葡萄球菌3例、肺炎克雷伯菌2例、铜绿假单胞菌1例和白念珠菌1例。胃管末端病原体培养阳性率与出生体重、住院天数和是否使用机械通气有关,胎龄、经口或经鼻插胃管对病原体培养结果无明显影响。结论患儿的出生体重、住院天数及是否使用机械通气影响胃管末端的病原体培养结果,提示留置胃管时应尽量遵循无菌操作原则,同时根据患儿的临床表现、血气分析结果等尽早期拔除气管插管,缩短机械通气的时间,提倡无创氧疗方式。

Objective To analyze the relevant factors of the culture positive rate of the neonatal indwelling gavage tube endings. Methods A total of 156 neonates admitted to neonatal intensive care unit in our hospital from May to August 2011 were selected. They were fed via indwelling gavage tubes. The tube endings were cultured and the factors related to culture results were analyzed. Results The culture positive rate was 39.1%. The bacteria included Bowman Acinetobacter （36 cases） , coagulase-negative staphylococci （10 cases） , Enterobacter cloacae （5 cases） , Escherichia coli （3 cases） , Staphylococcus aureus （3 cases） , Klebsiella pneumonia （2 cases） , Pseudomonas aeruginosa （1 case） , and Candida albicans （1 case）. The factors related to culture results included birth weight （P =0. 031 ）, hospital days （P =0. 009）, and ventilation （P =0. 025 ）. Gestational age, and oral or nasal gavage were not related. Conclusion Birth weight, hospital days and ventilation were related to the culture positive rate of the neonatal indwelling garage tube endings. The indwelling garage tubes must be conducted strictly based on aseptic principles. Meanwhile the duration of mechanical ventilation should be shortened and replaced by noninvasive ventilator.