新生儿肺炎继发性腹泻相关因素分析及微生态制剂的预防作用

Relative Factors of Secondary Diarrhea in Newborns With Pneumonia and the Value of Prophylactic Use of Probiotics

目的分析新生儿肺炎继发性腹泻的相关因素及微生态制剂的预防作用。方法选取2014年5月—2015年11月我科收治的758例肺炎患儿的临床资料进行回顾性分析。以应用抗生素的同时应用酪酸梭菌活菌散治疗的患儿为观察组(n=376),以单纯采用抗生素治疗或住院3 d出现肺炎继发性腹泻后才加用酪酸梭菌活菌散的患儿为对照组(n=382)。先采用单因素χ~2检验筛选出与新生儿肺炎继发性腹泻有关的因素,再采用非条件Logistic多因素回归分析其危险因素和保护因素。结果共有91例患儿发生继发性腹泻,其中观察组28例(7.53%),对照组63例(16.49%),观察组发生率低于对照组,差异具有统计学意义(χ~2=14.762,P<0.05)。单因素χ~2分析结果显示:置暖箱、喂养方式、侵入性操作、肠外静脉营养、是否预防性应用微生态制剂、住院时间、住院时患儿年龄、应用抗生素时间与肺炎继发性腹泻有关。非条件Logistic回归模型多因素分析进一步筛选出3个危险因素:采用配方奶喂养、抗生素使用时间、接受侵入性操作;2个保护因素:应用微生态制剂和患儿置暖箱。结论临床工作人员要警惕诱发和加重新生儿肺炎继发腹泻的相关因素;使用徽生态制剂(酪酸梭菌活菌散)可预防新生儿肺炎继发腹泻,可作为预防新生儿肺炎继发腹泻有效手段之一。

Objective To analyze the relative factors of secondary diarrhea in newborn with pneumonia and discuss the prevention function of probiotics. Methods Clinical data of 758 pneumonia newborns with diarrhea from May 2014 and November 2015 were retrospectively analyzed. The patients who had been undertaken antibiotic in combination with live clostridium butyricum were grouped as observation group（n=376）. The patients who had been undertaken antibiotic treatment only or suffered diarrhea 3 days after hospitalization and added live clostridium butyricum were grouped as control group（n=382）. Chi-square test was used to screen out the factors which associated with pneumonia newborns with diarrhea, then the unconditioned Logistic multifactor regression analysis was used to finger out the risk factors and protective factors. Results A total of 91 cases of newborn had secondary diarrhea with 28 cases from observation group（7.53%） and 63 cases from control group（16.49%）. The incidence of observation group was significantly lower than that of the control group（χ^2=14.762, P〈0.05）. Placement of incubator, feeding method, invasive operation, abenteric intravenous feeding, whether to use the preventive microecological pharmaceutics, days of hospitali-zation, age of the sick child at the admission, duration of time of using antihiotics were associated with pneumonia secondary diarrhea by Chi-square test analysis. Unconditional Logistic regression model analysis further revealed three risk factors： feeding with formulated milk, the duration of time of using antihiotics, and accepting the invasive operation, and two protection factors： aprophylactic use of probiotics and placement of incubator. Conclusion Clinical staff to be alert to the related factors of induce and aggravate secondary diarrhea in newborns with pneumonia. Probiotics can be used to reduce incidence of diarrhea of newborns with pneumonia.