摘要
目的统计第三军医大学第三附属医院极低出生体质量儿(VLBWI)的抗菌药物使用情况,以及院内感染发生率、转归、抗菌药物使用相关并发症,分析抗菌药物阶梯疗法对VLBWI院内感染的防治效果,指导临床正确使用抗菌药物,从而减少院内感染发生率。方法选择96例第三军医大学第三附属医院新生儿重症监护病房收治的VLBWI,抗菌药物降阶梯治疗为治疗组(20例重症患儿),升阶梯治疗为对照组(43例轻症患儿),回顾性调查两组患儿的临床资料,记录出生时胎龄、性别、体质量、母孕期状况、抗菌药物使用情况、院内感染发生情况、住院时间、总费用、抗菌药物使用相关并发症、转归等。结果 96例VLBWI入院时感染者83例(发生率86.45%),合并胎膜早破者感染发生率96.15%,机械通气者感染发生率95.65%,Apgar评分低者感染发生率90.63%。治疗组院内感染4例(20%),对照组院内感染4例(9.3%)(P>0.05);上机时间治疗组(平均6.65d)于对照组(平均5.07d),住院时间治疗组(平均31.9d)于对照组(平均27.37d),住院费用治疗组(平均57 911元)于对照组(平均46 443元),差异均无统计学意义(P>0.05);抗菌药物使用相关并发症(真菌感染)治疗组4例(发生率20%),对照组3例(发生率6.98%)(P>0.05),而肝肾损害、腹泻等无发生;治疗组死亡5例(病死率25%),对照组死亡8例(病死率18.6%)(P>0.05)。结论 VLBWI感染发生率较高,感染进展迅速,主要为肺部感染,胎膜早破、机械通气、Apgar评分低等是VLBWI感染的主要因素,早期使用降阶梯疗法可显著阻断重症患儿病情进展,挽救生命,缩短住院时间,提高成本效益比,而且不会显著增加院内感染率及抗菌药物使用相关并发症(真菌感染)发生率。
Objective To conduct the statistics on the use of antibacterial agents in very low birth weight infant（VLBWI）,the incidence of nosocomial infections,outcomes and the complications related to the use of antibacterial agents,to analyze of the control effect of the antibacterial agent ladder therapy on nosocomial infections in VLBWI for guiding correctly using antibacterial agents in clinc,thus reducing the incidence of nosocomial infections.Methods 96 cases of VLBWI treated in NICU of the third affiliated hospital of Third Military Medical University were selected.The antibacterial agent down-regulating therapy served as the treatment group（20severe cases）and the antibacterial agent up-regulating therapy as thecontrol group（43mild cases）.The clinical data in these two groups were retrospectively investigated.The gestational age,sex,body weight,the maternal condition during pregnancy,use situation of antibacterial agents,occurrence situation of nosocomial infections,length of hospital stay,total cost and antibacterial agent use related complications and outcomes were recorded.Results Among 96 cases of VLBWI,83cases（86.45%）had infection at admission to hospital.The infection occurrence rate in VLBWI complicating premature rupture of membranes was 96.15%,which in using mechanical ventilation was 95.65%and which in low Apgar score was 90.63%.The treatment group had 4cases（20%）of nosocomial infection and the control group also had 4cases（9.3%）of nosocomial infection（P〉0.05）.The use time of mechanical ventilation was mean 6.65 din the treatment group and mean 5.07 din the control group,the length of hospital stay was mean 31.9din the treatment group and mean 27.37 din the control group,the total cost was average 57 911 Yuan in the treatment group and average 46 443 Yuan in the control group（P〉0.05）.The antibacterial agent use related complication：4cases（20%）in the treatment group were fungal infection and 3cases（6.98%）in the control group（P〉0.05）,no liver and kidney dam
出处
《检验医学与临床》
CAS
2015年第14期1987-1989,共3页
Laboratory Medicine and Clinic
基金
全军医学科技青年培育项目(13QNP119)
关键词
抗菌药物阶梯疗法
极低出生体质量儿
院内感染
治疗效果
antibacterial agent ladder therapy
very low birth weight infant
nosocomial infection
treatment effect
