新生儿胎粪吸入综合征并发肺部感染病原菌特点及危险因素

Pathogenic bacteria characteristics and risk factors of neonatal meconium aspiration syndrome complicated with pulmonary infection

目的探究新生儿胎粪吸入综合征(MAS)并发肺部感染病原菌特点及危险因素。方法回顾性分析近年在新乡市妇幼保健院分娩的223例MAS患儿的临床资料,收集未并发肺部感染和合并肺部感染患儿的临床基本情况,分析病原菌特点,并对相关危险因素进行总结分析。结果在223例MAS患儿中,并发肺部感染61例(占27.35%),在痰标本中分离出病原菌75株。其中革兰阴性菌52株(69.33%)、革兰阳性菌21株(28.00%)、真菌2株(2.67%)。胎龄小于32周、出生体质量<1500 g、胎粪吸入分度为中重度、Apgar评分<7分、伴有胎膜早破、使用机械通气、血清白蛋白≤30 g/L是引起MAS并发肺部感染的独立危险因素(P<0.05)。使用肺表面活性剂、吸痰引流是MAS并发肺部感染的保护性因素(P<0.05)。结论MAS并发肺部感染与早产、低体重、中重度胎粪吸入、Apgar评分低、合并胎膜早破、使用机械通气、血清白蛋白水平低、吸痰引流、给予肺表面活性剂有关,临床可针对上述影响因素,采取积极措施,以预防肺部感染发生。

【Objective】To explore the pathogenic bacteria characteristics and risk factors of neonatal meconium aspiration syndrome(MAS)complicated with pulmonary infection.【Methods】The clinical data of 223 children with MAS who were delivered in our hospital in recent years were retrospectively analyzed.The basic clinical conditions of children without pulmonary infection and with pulmonary infection were collected,the characteristics of pathogens were analyzed,and the related risk factors were summarized and analyzed.【Results】In 223 cases of MAS,61 cases(27.35%)were complicated with pulmonary infection.Seventy-five strains of pathogens were isolated from sputum samples.There were 52 strains of gram negative bacteria(69.33%),21 strains of gram positive bacteria(28.00%)and 2 strains of fungi(2.67%).Gestational age before 32 weeks,birth weight<1500 g,meconium aspiration degree of moderate to severe,Apagar score<7,with premature rupture of membranes,mechanical ventilation,serum albumin≤30 g/L were independent risk factors for MAS complicated with pulmonary infection(P<0.05).The use of pulmonary surfactant and sputum suction and drainage were the protective factors of MAS complicated with pulmonary infection(P<0.05).【Conclusion】Pulmonary infection in MAS is related to premature birth,low weight,moderate and severe meconium aspiration,low Apagar score,premature rupture of membranes,use of mechanical ventilation,low serum albumin level,suction and drainage,and administration of lung surfactants.The above effects can be clinically addressed.Active measures should be taken to prevent the occurrence of lung infections.