超早产儿医院感染的临床研究

Nosocomial infection in extremely preterm infants

目的探讨超早产儿医院感染发生情况、危险因素及临床结局。方法选择2017年1月至2021年12月西北妇女儿童医院新生儿重症监护病房收治的超早产儿进行回顾性研究,根据是否发生医院感染分为医院感染组(简称院感组)和无医院感染组(简称无院感组),院感组根据临床结局再分为存活组和死亡组,采用χ2检验、t检验、非参数检验进行单因素分析,采用多元logistic回归分析医院感染及医院感染患儿死亡的危险因素。结果共纳入115例超早产儿,院感组67例(58.3%),其中1例放弃治疗,存活组54例,死亡组12例;无院感组48例。院感组中10例发生2次以上医院感染,共81例次,例次感染率为70.4%(81/115),其中晚发型败血症48例(41.7%),新生儿坏死性小肠结肠炎14例(12.2%),肺炎13例(11.3%),尿路感染和鹅口疮各1例(0.9%)。达全肠内营养时间长、合并有血流动力学意义的动脉导管未闭(hemodynamic significant patent ductus arteriosus,hsPDA)是超早产儿医院感染的独立危险因素(P<0.05)。与无院感组相比,院感组支气管肺发育不良发生率(100.0%比70.8%)、死亡率(17.9%比2.1%)更高(P<0.05)。脓毒性休克是超早产儿医院感染死亡的独立危险因素(P<0.05)。结论超早产儿医院感染的发生率较高,达全肠内营养时间长和合并hsPDA是超早产儿发生医院感染的独立危险因素;发生医院感染的超早产儿支气管肺发育不良发生率、死亡率较高,脓毒性休克是医院感染的超早产儿死亡的独立危险因素。

Objective To study risk factors and clinical outcomes of nosocomial infection(NI)in extremely premature infants(EPIs).Methods From January 2017 to December 2021,EPIs admitted to NICU of our hospital were retrospectively studied.The infants were assigned into NI group and non-NI group.The NI group were further assigned into survival group and death group.Single factor analysis was conducted using chi-square test,t-test and non-parametric test.Multiple logistic regression was used to analyze risk factors of NI and death.Results A total of 115 cases were enrolled,including 67(58.3%)in NI group,54 in survival group and 12 in death group.One case gave up treatment.48 cases were in non-NI group.81 episodes of nosocomial infections occurred in NI group and the case infection rate was 70.4%(81/115).48 cases(41.7%)had late-onset sepsis,14(12.2%)neonatal necrotizing enterocolitis,13(11.3%)pneumonia,1(0.9%)urinary tract infection and 1(0.9%)thrush.Hemodynamic significant patent ductus arteriosus(hsPDA)and long duration of parenteral nutrition were independent risk factors for NI in EPIs(P<0.05).The incidence of bronchopulmonary dysplasia(BPD)(100.0%vs.70.8%)and mortality(17.9%vs.2.1%)in NI group was higher than non-NI group(P<0.05).Septic shock was an independent risk factor for the death due to NI.Conclusions The incidence of NI in EPIs is high.hsPDA and long duration of parenteral nutrition are independent risk factors for NI in EPIs.EPIs with NI have high incidence of BPD and mortality and septic shock is an independent risk factor for death.