胎龄小于32周早产儿经不同抗生素应用策略治疗的效果比较及肠道菌群分析

Therapeutic effect comparison and intestinal flora analysis of premature infants with gestational age<32 weeks after different antibiotic administration strategies

目的分析胎龄小于32周早产儿经不同抗生素应用策略治疗的效果及对肠道菌群构成的影响。方法回顾性选取2021年1月至2022年6月河北中石油中心医院新生儿重症监护室(NICU)收治的178例胎龄<32周早产儿的临床资料,根据抗生素应用策略的不同分为观察组(88例)和对照组(90例)。对照组实施常规抗生素应用策略,观察组实施基于风险评估+感染筛查+监测的抗生素应用策略。比较两组抗生素使用情况、肠道菌群及预后情况。结果观察组肠外营养、机械通气及住院时间短于对照组(t值分别为6.200、6.341、13.639,P<0.05);观察组出生后7d、住院期间抗生素使用率及抗生素使用时间均低于对照组(t/χ^(2)值分别为18.116、19.967、20.571、21.680,P<0.05);出生后7d,观察组乳球菌属、杆菌属含量高于对照组(t值分别为4.391、5.485,P<0.05),乳球菌属、杆菌属构成比也高于对照组(χ^(2)值分别为6.200、13.639,P<0.05);住院期间,观察组过敏性哮喘、特异性皮炎、晚发型败血症(LOS)、≥Ⅲ度脑室内出血(IVH)的发生率均低于对照组,差异有统计学意义(χ^(2)值分别为6.593、7.303、3.899、4.582,P<0.05)。结论基于风险评估+感染筛查+监测的抗生素应用策略可缩短胎龄<32周早产儿抗生素使用、肠外营养、机械通气及住院时间,并降低抗生素使用率,防止肠道菌群减少,进而改善早产儿预后情况。

Objective To observe therapeutic effect of different antibiotic strategies on premature infants with gestational age<32 weeks,and analyze their influences on intestinal flora of the premature infants.Methods The clinical data of 178 premature infants with gestational age<32 weeks who were treated in neonatal intensive care unit(NICU)of Hebei PetroChina Central Hospital from January 2021 to June 2022 were analyzed retrospectively.They were divided into observation group(88 cases)and control group(90 cases)according to antibiotic administration strategy.The premature infants in the control group were given routine antibiotic administration strategy,while those in the observation group were given antibiotic administration strategy based on risk assessment+infection screening+monitoring.The antibiotic usage,intestinal flora and prognosis of the premature infants were compared between the two groups.Results The times of parenteral nutrition,mechanical ventilation and hospitalization length in the observation group were shorter than those in the control group(t=6.200,6.341 and 13.639 respectively,all P<0.05).The antibiotic use rate and antibiotic use time in the observation group were lower than those in the control group at 7d after birth and during hospitalization(t/χ^(2)=18.116,19.967,20.571 and 21.680 respectively,all P<0.05).At 7d after birth,the contents of Lactococcus and Bacillus of the premature infants in the observation group were higher than those in the control group(t=4.391 and 5.485 respectively,both P<0.05),and the composition ratios of Lactococcus and Bacillus were also higher than those in the control group(χ^(2)=6.200 and 13.639 respectively,both P<0.05).During hospitalization,the incidences of allergic asthma,atopic dermatitis,late-onset sepsis(LOS)and≥II degrees of intraventricular hemorrhage(IVH)in the observation group were lower than those in the control group,and the differences were statistically significant(χ^(2)=6.593,7.303,3.899 and 4.582 respectively,all P<0.05).Conclusion The antibiotic administration strategy based on risk assessment+infection screening+monitoring could shorten antibiotic use tirne,parenteral nutrition time,mechanical ventilation time and hospitalization length of these premature infants with gestational age less than 32 weeks,and reduce antibiotic use rate,prevent intestinal flora from decreasing,thus improve prognosis of these premature infants.