新生儿重症细菌性肺炎死亡相关危险因素分析

摘要

目的 探讨新生儿重症细菌性肺炎的死亡危险因素.方法 回顾分析2011年1月—2015年11月249例新生儿重症细菌性肺炎患儿的临床资料,分析死亡相关因素.结果 249例患儿中,死亡45例,病死率18.07%.细菌培养检出病原菌251株,前5位病原菌依次为大肠埃希菌、金黄色葡萄球菌、肺炎克雷伯菌、肺炎链球菌及表皮葡萄球菌.单因素分析显示,死亡组与存活组的出生胎龄、胎膜早破、入院时日龄、出生体质量、喂养方式、Apgar评分、总胆红素值、并发症、创伤性治疗、肠外营养和多重耐药菌感染之间差异有统计学意义(P均<0.05).多因素logistic回归分析显示,入院时日龄<7天(OR=4.30,95%CI:1.74～10.64)、Apgar评分<7分(OR=3.24,95%CI:1.23～8.49)、有并发症(OR=6.81,95%CI:2.65～17.46)、多重耐药菌感染(OR=6.16,95%CI:1.90～19.99)及创伤性治疗(OR=3.82,95%CI:1.03～14.16)是新生儿重症细菌性肺炎患儿死亡的独立危险因素(P均<0.05).结论 新生儿重症细菌性肺炎病死率较高,入院时日龄小、Apagar评分低、有并发症、多重耐药菌感染及创伤性治疗是死亡的主要危险因素.%Objective To explore the risk factors of mortality in neonates with severe bacterial pneumonia. Method The clinical data of 249 neonates with severe bacterial pneumonia from January 2011 to November 2015 were analyzed retrospectively, and the related factors of mortality were analyzed. Results Of the 249 children, 45 died and mortality rate was 18.07%. A total of 251 strains of pathogenic bacteria were detected in the bacterial culture, and the top 5 pathogens were Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae, Streptococcus pneumoniae and Staphylococcus epidermidis. Univariate analysis showed that the gestational age, premature rupture of membranes, age at the time of hospital admission, birth weight, feeding, Apgar score, total bilirubin, complications, traumatic treatment, parenteral nutrition, and multidrug-resistant bacteria infection between the death group and survival group were significantly different (all P<0.05). Multivariate logistic regression analysis showed that the age at admission <7 days (OR=4.30, 95%CI: 1.74～10.64), Apgar scores <7 (OR=3.24, 95%CI: 1.23～8.49), and having complications (OR=6.81, 95%CI: 2.65～17.46), multidrug-resistant bacteria infection (OR=6.16, 95%CI: 1.90～19.99) and traumatic therapy (OR=3.82, 95%CI: 1.03～14.16) were the independent risk factors of mortality in neonatal severe bacterial pneumonia (all P <0.05). Conclusion The mortality rate of neonatal severe bacterial pneumonia is relatively high. And the main risk factors of death were the age at admission <7 days, Apgar scores <7, and having complications, multidrug- resistant bacteria infection and traumatic therapy.