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 on the etiological distribution and influencing factors of infectious pneumonia complicated with 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2017年3月~2018年9月我院收治的96例窒息新生儿作为研究对象,分析其临床资料,并采集鼻腔或喉部分泌物进行病原菌培养,通过病原学检测探讨新生儿窒息并发感染性肺炎的病原学分布情况及影响因素。结果96例窒息新生儿出现感染性肺炎27例(28.1%),检测出25株致病菌,其中革兰阳性菌5株,以金黄色葡萄球菌为主;革兰阴性菌18株,以大肠埃希菌、肺炎克雷伯杆菌为主;真菌2株(8.0%)均为白色假丝酵母菌。肺部感染与无肺部感染患儿的出生体重、Apgar评分、贫血、胎膜早破、胎盘前置、胎盘早剥、羊水污染、气管插管情况比较,差异有统计学意义(P<0.05);对危险因素进行多因素非条件Logistic回归分析可知,出生体重<1.5 kg、Apgar评分0~3分、胎膜早破、羊水污染、气管插管是新生儿窒息并发感染性肺炎的独立危险因素(P<0.05)。结论新生儿窒息并发感染性肺炎病原菌以革兰阴性菌为主,出生体重<1.5 kg、Apgar评分0~3分、胎膜早破、羊水污染、气管插管是新生儿窒息并发感染性肺炎的独立危险因素。

Objective To explore the etiological distribution and influencing factors of infectious pneumonia in asphyxia neonatorum.Methods Ninety-six asphyxiated newborns admitted to our hospital from March 2017 to September 2018 were selected as the research objects.Their clinical data were analyzed.Some nasal or laryngeal secretions were collected for pathogenic bacteria culture.The pathogenic distribution and influencing factors of neonatal asphyxia complicated with infective pneumonia were investigated by pathogenic detection.Results The 27 cases(28.1%)of infectious pneumonia occurred in 96 asphyxiated newborns.The 25 pathogenic bacteria were detected,including 5 Gram-positive bacteria,mainly Staphylococcus aureus,18 Gram-negative bacteria,mainly Escherichia coli and Klebsiella pneumonia,and 2 fungi(8.0%)were Candida albicans.There were significant differences in birth weight,Apgar score,anemia,premature rupture of membranes,placenta previa,placental abruption,amniotic fluid contamination and tracheal intubation between pulmonary infection and non-pulmonary infection,the differences were statistically significant(P<0.05).Multivariate unconditional Logistic regression analysis showed that birth weight<1.5 kg,Apgar score 0-3,premature rupture of membranes,amniotic fluid pollution and tracheal intubation were independent risk factors for neonatal asphyxia complicated with infectious pneumonia(P<0.05).Conclusion Gram-negative bacteria were the main pathogens of neonatal asphyxia complicated with infectious pneumonia.Birth weight<1.5 kg,Apgar score 0-3,premature rupture of membranes,amniotic fluid pollution and tracheal intubation are independent risk factors for neonatal asphyxia complicated with infective pneumonia.