新生儿窒息并发感染性肺炎的病原学分布及其影响因素分析

Analysis of the pathogenic distribution and influencing factors of infectious pneumonia after neonatal asphyxia

目的探讨新生儿窒息并发感染性肺炎的病原学分布及其影响因素。方法选取2015年1月至2017年9月本院收治的185例窒息新生儿为研究对象,分析入选新生儿出生后1个月内的临床资料,判断其是否并发感染性肺炎,探讨新生儿窒息并发感染性肺炎的病原学分布情况,比较不同临床特征的窒息新生儿感染性肺炎的发生率。结果 185例窒息新生儿中发生感染性肺炎55例(29.7%)。检出致病菌53株,其中革兰阴性菌39株(73.6%),以大肠埃希菌最常见;革兰阳性菌8株(15.1%),以金黄色葡萄球菌最常见;真菌6株(11.3%),均为白色假丝酵母菌。单因素分析显示,不同出生胎龄、出生体重及清蛋白水平的窒息新生儿感染性肺炎发生率比较差异均具有显著性(P<0.05),自然分娩、胎盘早剥、前置胎盘、胎膜早破、贫血、Apgar评分为0~3分、气管插管的窒息新生儿感染性肺炎发生率显著升高(P<0.05)。多因素Logistic回归分析结果显示,出生体重<1.5 kg、胎膜早破、Apgar评分为0~3分、气管插管是新生儿窒息后并发感染性肺炎的独立危险因素(P<0.05)。结论感染性肺炎是新生儿窒息的常见并发症,病原菌以大肠埃希菌为主的革兰阴性菌常见,出生体重<1.5 kg、胎膜早破、Apgar评分为0~3分、气管插管是新生儿窒息后并发感染性肺炎的独立危险因素。

Objective To investigate the pathogenic distribution and influencing factors of infectious pneumonia after neonatal asphyxia.Method 185 cases of neonatal asphyxia in our hospital from January 2015 to September 2017 were enrolled as the study subjects,and their clinical datas within 1 month after birth were collected and judged whether occurrence of infectious pneumonia,analyzed the distribution of etiology of infectious pneumonia after neonatal asphyxia and compared the incidence of infectious pneumonia in newborns with different clinical characteristics.Result Infectious pneumonia occurred in 55 newborns,and the total incidence was 29.7%.Among them,53 strains of pathogens were detected,including 39 strains(73.6%)of Gram negative bacteria(Escherichia coli was the most common),8 strains(15.1%)of Gram positive bacteria(Staphylococcus aureus the most common)and 6 strains(11.3%)of fungi(all were Candida albicans).Single factor analysis showed that there were statistically significant differences in incidences of infectious pneumonia among different gestational age,birth weight,blood levels of albumin(P<0.05).The incidences of infectious pneumonia in newborns with natural labor,placental abruption,placenta praevia,premature rupture of membranes(PROM),anemia,Apgar score of 0~3 points and trachea cannula increased significantly(P<0.05).Multivariate Logistic regression analysis showed that birth weight<1.5 kg,PROM,Apgar score of 0~3 points and trachea cannula were the independent risk factors of infectious pneumonia after neonatal asphyxia(P<0.05).Conclusion Infectious pneumonia is a common complication of neonatal asphyxia.Gram negative bacteria is the most common pathogenic bacteria,primarily Escherichia coli.Birth weight<1.5 kg,PROM,Apgar score of 0~3 points and trachea cannula are the independent risk factors of infectious pneumonia after neonatal asphyxia.