孕妇胎膜早破与新生儿感染的临床分析及抗菌药物应用

Clinical analysis of premature rupture of membranes of pregnant women with neonatal infections and antimicrobial application

目的探讨孕妇胎膜早破与新生儿感染的临床关系、常见病原菌分布及抗菌药物的敏感性,以降低新生儿感染率。方法选取2008年4月-2013年4月胎膜早破孕妇1 507例,对其临床资料进行回顾性分析,根据新生儿是否发生感染进行分组,感染组22例、未感染组1 485例,探讨胎膜早破与新生儿感染发生的关系,并对感染新生儿进行病原学分析和药敏试验,采用SPSS13.0软件进行统计分析。结果 1 507例胎膜早破孕妇发生新生儿感染22例,感染率为1.46%,其中下呼吸道感染13例占59.09%,皮肤感染5例占22.73%,眼部感染3例占13.64%,胃肠道感染1例占4.55%;对孕妇胎膜早破及分娩发生新生儿感染进行分析,发现随着破膜时间的延长以及孕周的降低,孕妇有胎膜早破发生新生儿感染的比例明显增加;此外胎膜早破之后采取剖宫产分娩者新生儿感染概率增加,差异有统计学意义(P<0.05);22例发生感染的新生儿中共检出病原菌27株,其中大肠埃希菌10株占37.04%,金黄色葡萄球菌6株占22.22%,白色假丝酵母菌4株占14.81%,溶血性链球菌2株占7.41%,其他5株占18.52%。结论新生儿感染与胎膜早破发生的时间、胎儿孕周以及分娩方式密切相关,在临床中应早期进行诊断,行细菌培养和药敏试验,先根据经验行敏感药物治疗,并及时根据检查结果调整药物,改善患儿的预后。

OBJECTIVE To investigate the clinical relationship between neonatal infection and premature rupture of membranes of pregnant women and the distribution of common pathogenic microorganisms and antimicrobial sus- ceptibility, so as to reduce neonatal infection rates. METHODS Totally 1 507 pregnant women with PROM from April 2008 to April 2013 were elected, the clinical data were retrospectively analyzed; according to whether the newborn infection occurred, they were divided into two groups, the infection group was 22 cases and the uninfect- ed group was 1485 cases. The relationship between the premature rupture of membranes and the occurrence of neonatal infection was explored. The etiology analysis and drug sensitive test were used to infect neonatal. The SPSS13.0 software was used for statistical analysis. RESULTS There were 22 cases of neonatal with infection among the 1507 cases of PROM; the infection rate was 1.46%. Of which 13 cases of lower respiratory tract infec- tions （59.09%）, skin infections in 5 cases （22.73%）, eye infections in 3 cases （la. 64%）, gastrointestinal infec- tions in 1 case （4.55 %）. On the occurrence of hospital infections of the newborn premature rupture of membranes and delivery situation analysis of the situation and found that the extension of time as well as the rupture of lower gestational age, premature rupture of neonatal nosocomial infection was significantly increased; addition mem- branes early break taken after cesarean deliveries increased risk of neonatal infection, the difference was significant （P〈0.05）. 27 strains of pathogens were detected among the 22 cases occurred in the hospital＇s neonatal, inclu- ding 10 strains of E. coli （37.04%）, 6 strains of Staphylococcusaureus （22.22%） ,4 strains of Candida albicans （14.81%） ,2 strains of hemolytic chain cocci （7.41%） and 5 strains of the other （18.52%）. CONCLUSION The neonatal infection with the time of premature rupture of membranes, fetal gestational weeks and delivery mode are closely related. They should be diagnosed early in the clinical, and we should perform bacterial culture and sensi- tivity test. Firstly, they should be cured by the drug therapy according to the experience of sensitive, then timely adjust drug according to test results so as to improve the patient＇s prognosis.