围生期宫内感染早期识别与出生结局
摘要
目的探讨宫内感染新生儿早期诊断的必要性,评估宫内感染后呼吸系统并发症对新生儿预后的意义。方法回顾性分析2016年6月1日至2017年12月1日在本院儿科重症监护室收治的193例诊断为宫内感染的新生儿的资料,其中有19例患儿无呼吸系统并发症,故不计入分组。根据有无并发症分为无并发症组(58例)、新生儿肺炎组(84例)和新生儿呼吸窘迫组(32例),分析引起感染的相关因素、临床表现、辅助检查特点,其中无并发症组给予抗感染及对症治疗;肺炎组除上述处理外给予呼吸管理;呼吸窘迫组除肺炎处理外,根据病情给予肺表面活性物质和(或)呼吸支持治疗,比较不同组别的住院日情况。结果新生儿宫内感染最常并发早产、肺炎和新生儿呼吸窘迫综合征;检验结果中降钙素原敏感性最高;治疗转归与并发症相关,无并发症组、新生儿肺炎组和呼吸窘迫组平均住院日存在差异,并发新生儿肺炎、新生儿窘迫综合征患儿的住院天数明显延长。结论宫内感染早期诊断有利于干预宫内感染引发的并发症,提高生存质量。
引文
1 王晓玲,赵智勇,葛昌玲,等.新生儿宫内感染68例临床分析.临床合理用药杂志,2008,19:193.
2 Hagberg H,Mallard C,Ferriero DM,et al.The role of in?ammation in perinatal brain injury.Nat Rev Neurol,2015,11:192-208.
3 杜楚颖,张建平.宫内感染早期诊断.中国实用妇科与产科杂志,2014,30:418-421.
4 Hackney DN,Kelly K,Petersen RJ,et al.Determinants of the competing outcomes of intrauterine infection,abruption,or spontaneous preterm birth after preterm premature rupture of membranes.J Matern Fetal Neonatal Med,2016,29:258-263.
5 蒋人贵,冯伊利,李成军,等.胎膜早破导致新生儿感染的常见病原菌分布.中华 医院 感染 学杂 志,2013,23:1094-1096.
6 Vrachnis N,Vitoratos N,Iliodromiti Z,et al.Intrauterine inflammation and preterm delivery.Ann N Y Acad Sci,2010,1205:118-122.
7 张伟新,黄为民.宫内感染的参考诊断及对早产儿的影响.现代医院,2016,16:953-956.
8 胡蓉,李笑天.围生期细菌性感染的诊治策略.实用妇产科杂志,2011,27 :653-654.
9 晶慧,毛健.宫内感染与早产儿脑白质损伤发病机制研究.中国中西医结合儿科学,2006,25:65-66.
10 Pilypien I,Drazdien N,Dumalakien I,et al.The significance of fetal inflammatory response syndrome in early and later adaptation of premature infants.Arch Gynecol Obstet,2015,291:67-72.
11 王海燕.胎膜早破孕妇血清IL-6、CRP水平与宫内感染的关系.继续医学教育,2014,28:36-38.
12 Samejima T,Takechi K.Elevated C-reactive protein levels in histological chorioamnionitis at term:impact of funisitis on term neonates.J Matern Fetal Neonatal Med,2017,30:1428-1433.
13 Oludag T,Gode F,Caglayan E,et al.Value of maternal procalcitonin levels for predicting subclinical intra-amniotic infection in preterm premature rupture of membranes.J Obstet Gynaecol Res,2014,40:954-960.
2 Hagberg H,Mallard C,Ferriero DM,et al.The role of in?ammation in perinatal brain injury.Nat Rev Neurol,2015,11:192-208.
3 杜楚颖,张建平.宫内感染早期诊断.中国实用妇科与产科杂志,2014,30:418-421.
4 Hackney DN,Kelly K,Petersen RJ,et al.Determinants of the competing outcomes of intrauterine infection,abruption,or spontaneous preterm birth after preterm premature rupture of membranes.J Matern Fetal Neonatal Med,2016,29:258-263.
5 蒋人贵,冯伊利,李成军,等.胎膜早破导致新生儿感染的常见病原菌分布.中华 医院 感染 学杂 志,2013,23:1094-1096.
6 Vrachnis N,Vitoratos N,Iliodromiti Z,et al.Intrauterine inflammation and preterm delivery.Ann N Y Acad Sci,2010,1205:118-122.
7 张伟新,黄为民.宫内感染的参考诊断及对早产儿的影响.现代医院,2016,16:953-956.
8 胡蓉,李笑天.围生期细菌性感染的诊治策略.实用妇产科杂志,2011,27 :653-654.
9 晶慧,毛健.宫内感染与早产儿脑白质损伤发病机制研究.中国中西医结合儿科学,2006,25:65-66.
10 Pilypien I,Drazdien N,Dumalakien I,et al.The significance of fetal inflammatory response syndrome in early and later adaptation of premature infants.Arch Gynecol Obstet,2015,291:67-72.
11 王海燕.胎膜早破孕妇血清IL-6、CRP水平与宫内感染的关系.继续医学教育,2014,28:36-38.
12 Samejima T,Takechi K.Elevated C-reactive protein levels in histological chorioamnionitis at term:impact of funisitis on term neonates.J Matern Fetal Neonatal Med,2017,30:1428-1433.
13 Oludag T,Gode F,Caglayan E,et al.Value of maternal procalcitonin levels for predicting subclinical intra-amniotic infection in preterm premature rupture of membranes.J Obstet Gynaecol Res,2014,40:954-960.