动脉导管未闭早产患儿合并肺部感染的危险因素分析及护理对策

Risk factors analysis and nursing strategies for pulmonary infection in premature infants with patent ductus arteriosus

目的分析动脉导管未闭(PDA)早产患儿合并肺部感染的危险因素,并提出相应的护理策略,为预防PDA早产患儿合并肺部感染提供参考。方法收集2018年7月至2020年12月浙江大学医学院附属儿童医院收治的144例PDA早产患儿资料,根据是否合并肺部感染分为感染组(85例)和非感染组(59例),比较两组患者临床特征,采用多因素logistic回归分析影响PDA早产患儿发生肺部感染的独立危险因素。结果144例PDA早产患儿合并肺部感染的发生率为59.03%。共分离出病原菌株96株,其中革兰阴性菌72株,以克雷伯杆菌为主。革兰阳性菌24株,以金黄色葡萄球菌为主。多因素logistic回归分析发现气管插管次数≥2次、有低蛋白血症、PDA直径≥3 mm、胎龄<28周、有经外周静脉穿刺中心静脉置管是PDA早产患儿发生肺部感染的独立危险因素(均P<0.05)。结论PDA早产患儿合并肺部感染为多因素综合作用的结果,临床上应采取针对性的综合治疗和护理策略来预防其发生。

Objective To analyze the risk factors for pulmonary infection in preterm infants with patent ductus arteriosus(PDA)so as to provide a basis for the prevention strategies.Methods Data of 144 premature delivery children with PDA admitted to the Children's Hospital Affiliated to Zhejiang University School of Medicine from July 2018 to December 2020 were collected.They were divided into an infected group(85 cases)and a non infected group(59 cases)based on the occurrence of pulmonary infection.Univariate analysis was performed on data of the two groups,and statistically significant factors were included in logistic regression analysis for independent risk factors.Results Among 144 premature delivery cases with PDA,85 cases were complicated with pulmonary infection,with an infection rate of 59.03%.A total of 96 infected strains were isolated,including 72 Gram negative bacteria,mainly Klebsiella pneumoniae,and 24 strains of Gram positive bacteria,mainly Staphylococcus aureus.Multivariate logistic regression analysis found that more than 2 tracheal intubations,had hypoproteinemia,PDA diameter greater than 3 mm,gestational age less than 28 weeks,had peripherally inserted central venous catheters were independent risk factors for pulmonary infection in PDA premature infants(all P<0.05).Conclusion The occurrence of pulmonary infection in premature infants with PDA is the result of a combined actions of multiple factors.Not only these factors but also their combined effects should be considered to provide comprehensive prevention and treatment strategies for pulmonary infection.