足月小于胎龄儿医院感染因素临床相关分析

摘要

目的：探讨足月小于胎龄儿医院感染发病的危险因素。方法：回顾性分析足月小于胎龄儿病例的相关资料，将生后24小时入院、住院时间>48 h、排除产前细菌感染史的病例，按照是否发生医院感染分为感染组和非感染组，将出生体重<1.8 kg、胎膜早破>12 h、羊水混浊等13项因素作为可疑危险因素，应用χ2检验和多因素非条件Logistic回归分析，明确足月小于胎龄儿医院感染的独立危险因素。结果：单因素分析结果显示：胎膜早破>12 h、羊水粪染、37周≤胎龄<40周、出生体重<1.8 kg、开奶时间>5 d、住院时间>10 d、反复吸痰（插管）、预防性应用抗生素等8项因素与医院感染相关；进一步Logistic多因素回归分析显示：出生体重<1.8 kg、胎膜早破>12 h、住院时间>10 d为足月小于胎龄儿医院感染的独立危险因素。结论：预防足月小于胎龄儿医院感染的有效措施为加强产前保健，定期产前检查，从根本上减少足月小于胎龄儿的出生；对于妊娠超过37周，胎膜早破>12 h病例，应适时终止妊娠；对住院时间较长的患儿，应严格执行NICU的消毒隔离制度，避免交叉感染，防止院内感染的发生。%Objective To investigate risk factors of nosocomial infection in small full-term gestational age. Methods The retrospec-tive study was conducted from hospital admissions in the neonatal intensive care unit of affiliated chaozhou central hospital of southern medi-cal university. Infants admitted within 24 hours after birth with NICU stay longer than 48 hours,and without prenatal history of bacterial in-fection were chosen for this study. The infants were divided into two groups with infection group and without infection group. 13 factors were subjected toχ2 test and logistic regresson analysis to independent risk factors that lead to nosocomial infections of small full-term gestation-al age. Results Single factor revealed that the following 8 factors:premature rupture of membranes longer than 12 hours,amniotic fluid of faecal pollution,37W≤GA<40 W,BW<1. 8 kg,delayed gastric feeding starting after 5 days,time of hospital stay longer than 10 days,re-peated sputum suction( cannula),and prophylactic antibiotic usage were related to nosocomial infection. Logistic regresson analysis further revealed that BW<1. 8 kg,premature rupture of membranes longer than 12 hours,time of hospital stay longer than 10 days were the inde-pendent risk factors for nosocomial infection. Conclusion Improvement of antenatal care and regular examination to reduce the small full-term gestational age birth is the most effective measure to reduce nosocomial infection. For the GA≥37 W,premature rupture of membranes longer than 12 hours,need to stop gestation in a good time. For the neonates which stay longer time in hospital,need to carry out strictly de-gassing and quarantire regime of NICU,avoid cross infection and nosocomial infection.