早产儿中枢神经系统感染病因分析及干预措施

摘要/Abstract

摘要： 目的调查分析早产儿中枢神经系统感染病因,并提出了相关干预措施。方法选取2019年6月—2022年5月在北京市房山区妇幼保健院住院的92例早产儿作为研究对象,判定中枢神经系统感染情况,调查所有早产儿的一般资料,并进行病因的多因素分析。所有中枢神经系统感染早产儿给予对症治疗干预,调查患儿预后情况。结果 92例早产儿中,发生中枢神经系统感染12例（感染组）,占比13.04%。感染病原体分别为李斯特菌1例、无乳链球菌2例、肺炎克雷伯菌7例、大肠埃希菌1例、人葡萄球菌1例。感染组早产儿的性别、胎龄、体重等与非感染组比较,差异无统计学意义（P>0.05）;感染组早产儿的5 min Apgar评分、早产儿住院时间、早产儿窒息、母体妊娠期间感染、早产儿鼻吸氧等与非感染组比较,差异有统计学意义（P<0.05）。Spearman分析显示5 min Apgar评分、早产儿住院时间、早产儿窒息、母体妊娠期间感染、早产儿鼻吸氧与中枢神经系统感染存在相关性,差异有统计学意义（P<0.05）。Logistic回归分析显示5 min Apgar评分、早产儿住院时间、早产儿窒息、母体妊娠期间感染都为导致早产儿中枢神经系统感染的重要因素,差异有统计学意义（P<0.05）。经过对症治疗3个月后,12例患儿Gesell量表大运动、语言、个人-社交能力、精细动作、适应性行为等评分都显著高于治疗前,智力发育指数、运动发育指数与治疗前相比也显著提高,差异有统计学意义（P<0.05）。结论早产儿中枢神经系统感染在临床上比较常见,病原体多为肺炎克雷伯菌,5 min Apgar评分、早产儿住院时间、早产儿窒息、母体妊娠期间感染都是导致早产儿中枢神经系统感染的重要因素,加强早期治疗能显著改善患儿的综合发育状况。

关键词: 早产儿, 中枢神经系统感染, 肺炎克雷伯菌, 病因, Gesell量表评分, Apgar评分

Abstract: Objective To investigate and analyse the causes of central nervous system infection in premature infants and put forward relevant intervention measures. Methods 92 cases of premature infants hospitalized in Beijing Fangshan District Maternal and Child Health Care Hospital from June 2019 to May 2022 were selected as the study subjects. All the cases were examined to determine the infection of the central nervous system, and the general data of all premature infants were investigated. Multifactor analysis of the etiology was conducted. All premature infants with central nervous system infection were given symptomatic treatment intervention, and were to investigate the prognosis of the children. Results The central nervous system infection occurred in 12 cases of 92 premature infants (infection group), accounting for 13.0%. The infectious pathogens were Listeria monocytogenes in 1 case, Streptococcus lactis in 2 cases, Klebsiella pneumoniae in 7 cases, Escherichia coli in 1 case, and Staphylococcus aureus in 1 case. There were no significant differences in sex, gestational age and weight compared between the infected group and the non-infected group(P>0.05). There were significant difference compared between the infected group and the non-infected group(P<0.05) in the 5-minute Apgar score, hospitalization stay of premature infants, asphyxia of premature infants, infection during maternal pregnancy, and nasal oxygen inhalation of premature infants. Spearman analysis showed that the 5 min Apgar score, hospitalization time of premature infants, asphyxia of premature infants, infection during maternal pregnancy, nasal oxygen inhalation of premature infants were correlated with central nervous system infection(P<0.05). Logistic regression analysis showed that 5 min Apgar score, hospitalization time of premature infants, asphyxia of premature infants and maternal infection during pregnancy were all important factors leaded to central nervous system infection of premature infants(P<0.05). After 3 months of symptomatic treatment, 12 children's Gesell scale exercise, language, personal-social ability, fine movement and adaptive behavior were significantly higher than before treatment, and the intellectual development index and motor development index were also significantly improved compared with before treatment(P<0.05). Conclusion The central nervous system infection of premature infants is relatively common in clinical practice. Klebsiella pneumoniae as pathogen, 5 min Apgar score, hospitalization stay of premature infants, asphyxia of premature infants, and maternal infection during pregnancy are all important factors leading to the central nervous system infection of premature infants. Strengthening early treatment can significantly improve the comprehensive development of children.

Key words: premature infants, central nervous system infection, klebsiella pneumoniae, pathogeny, gesell scale score, apgar score

中图分类号:

R741

隗秋连. 早产儿中枢神经系统感染病因分析及干预措施[J]. 中华养生保健, 2023, 41(18): 35-38.

KUI Qiu-lian. Etiological analysis and intervention measures of central nervous system infection in premature infants[J]. ZHONGHUA YANGSHENG BAOJIAN, 2023, 41(18): 35-38.

参考文献

[1] 海峡两岸医药卫生交流协会,新生儿学专业委员会.新生儿循证医学学组.早产儿支气管肺发育不良出院后随访管理专家共识[J].中国当代儿科杂志,2022,24(5):455-465.
[2] 张文红,王翠翠,王小康,等.硫酸多黏菌素B治疗极早早产儿感染泛耐药肺炎克雷伯菌1例[J].山东大学学报(医学版),2022,60(2):121-124.
[3] 曾国芬,李晓杰,梁家隐,等.不同方法在中枢神经系统感染病原学诊断中的价值[J].中国感染控制杂志,2022,21(8):768-773.
[4] 李世杰,张金晶,黄鸿眉,等.Griffiths发育评估量表与Gesell发育诊断量表在细菌性脑膜炎婴儿发育评估中的一致性研究[J].北京医学,2022,44(6):510-512,517.
[5] 曾康,黄阿娟,郑曼利,等.早产儿和足月儿持续性肺动脉高压的危险因素比较[J].岭南心血管病杂志,2022,28(4):328-333.
[6] 吴宇鑫. 足月新生儿颅内出血病因研究进展[J].重庆医学,2022,51(13):2331-2335.
[7] 张毅,沈淳,薛萍,等.产前检查及手术策略对新生儿脑积水分流障碍的影响研究[J].临床小儿外科杂志,2022,21(9):815-819.
[8] 何疏梅,赵晓芬,和灿林,等.新生儿难治性化脓性脑膜炎临床特点及高危因素分析[J].中国医药导报,2022,19(24):93-97.
[9] 王雨倩,杨柳.微生物-肠-脑轴在早产儿脑白质损伤发病机制中的研究进展[J].国际儿科学杂志,2022,49(11):754-758.
[10] 曹广娜,张扬,常艳美,等.脑室帽状腱膜下引流术治疗早产儿脑室内出血后脑积水的疗效分析[J].临床小儿外科杂志,2022,21(3):242-247.
[11] 胡南非,谭李红,廖镇宇,等.肠道菌群与早产儿晚发型败血症关系的初步研究[J].中国医师杂志,2022,24(7):1023-1027.
[12] 余倩. 早产儿出院后随访管理及早期干预临床效果和预后分析[J].山西医药杂志,2021,50(3):408-410.
[13] 丁宁,李菲,陈虹.早产儿贫血的危险因素及贫血对神经心理发育的影响[J].医学综述,2021,27(2):395-399.
[14] 王华倩,姚宝珍,叶静萍,等.高龄产妇的晚期早产儿早期体格和神经发育分析[J].武汉大学学报(医学版),2021,42(3):452-456.
[15] 潘维伟,童笑梅,李在玲.母乳喂养与人工喂养对早产儿脑白质损伤预后的影响[J].中国儿童保健杂志,2021,29(8):820-823.
[16] 臧月珍,张铭珠,朱玲玲.脑损伤早产儿远期神经发育的影响因素分析[J].实用临床医药杂志,2021,25(1):113-116.
[17] 刘云峰,黄春玲,童笑梅,等.早产儿梗阻性脑积水外科治疗与预后的临床研究[J].中国当代儿科杂志,2021,23(12):1214-1220.
[18] 马莉,王小平,王丽.“袋鼠式护理”对新生儿神经行为的影响——评《实用新生儿护理手册》[J].中国实验方剂学杂志,2021,27(20):161-167.
[19] 白瑞苗,曾军安,杨云帆,等.17例新生儿李斯特菌败血症的临床特征及结局分析[J].中国妇幼健康研究,2021,32(3):453-458.
[20] 赵彩雯,赵鑫,刘彦超,等.出生后感染/炎症对早产儿脑白质微结构影响的DTI研究[J].临床放射学杂志,2021,40(12):2362-2366.