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目的探讨新生儿肺出血合并宫内感染的临床特点及诊治方法,提高临床对新生儿肺出血合并宫内感染的认识及诊治水平。方法回顾性分析新生儿重症监护病房(NICU)2009年1月-2012年12月收治的39例肺出血新生儿的临床资料,其中28例患儿合并宫内感染,设为感染组,11例患儿未合并宫内感染,设为未感染组,比较两组患儿的临床资料,总结肺出血合并宫内感染的高危因素,并对合并宫内感染患儿的感染部位、感染病原菌及治疗方法进行分析,所得数据采用SPSS13.0软件进行统计分析。结果 39例新生儿肺出血患儿并发宫内感染28例,感染率71.79%;感染组和未感染组新生儿在肺透明膜病、新生儿窒息、早产、出生体质量<1 500g等比较差异有统计学意义(P<0.05),经logistic多因素回归分析,肺透明膜病、新生儿窒息、早产为新生儿肺出血合并宫内感染的高危因素;28例宫内感染患儿共检出病原体36株,病原体主要以革兰阴性菌为主24株占66.67%,其次为解脲脲支原体7株和革兰阳性菌5株,分别占19.44%和13.89%;39例肺出血患儿经治疗后,4例患儿死亡,病死率10.25%,6例患儿放弃治疗,29例患儿治愈出院。结论新生儿宫内感染是导致肺出血重要原因,加强孕产期保健、对重症感染患儿加强监护可以减少肺出血的发生。
Objective To investigate the clinical features, diagnosis and treatment of neonatal pulmonary hemorrhage complicated with intrauterine infection and to improve the understanding and diagnosis and treatment of neonatal pulmonary hemorrhage with intrauterine infection. Methods The clinical data of 39 neonates with pulmonary hemorrhage admitted to neonatal intensive care unit (NICU) from January 2009 to December 2012 were retrospectively analyzed. Among them, 28 cases were complicated with intrauterine infection, Children without intrauterine infection, as the uninfected group, the clinical data of two groups were compared to summarize the risk factors for pulmonary hemorrhage complicated with intrauterine infection, and infection in children infected with intrauterine infection, the infection of pathogens and treatment Methods were analyzed, the data obtained using SPSS13.0 software for statistical analysis. Results Among the 39 cases of neonatal pulmonary hemorrhage, 28 cases were complicated with intrauterine infection, the infection rate was 71.79%. There were significant differences in hyaline membrane disease, neonatal asphyxia, premature delivery and birth weight <1 500g between infected group and non-infected group (P <0.05). According to the logistic multivariate regression analysis, hyaline membrane disease, neonatal asphyxia and premature labor were the risk factors of neonatal pulmonary hemorrhage complicated with intrauterine infection. Twenty-eight cases of intrauterine infection were detected Thirty-six strains of pathogens were found, of which 24 were gram-negative bacteria and 66.67% were pathogens, followed by 7 strains of Ureaplasma urealyticum and 5 strains of Gram-positive bacteria, accounting for 19.44% and 13.89% respectively. 39 cases of pulmonary hemorrhage After treatment, 4 patients died, the mortality rate was 10.25%, 6 patients gave up treatment, 29 patients were cured and discharged. Conclusion Neonatal intrauterine infection is an important cause leading to pulmonary hemorrhage. It is necessary to strengthen the maternal health care and to strengthen the monitoring of children with severe infections to reduce the incidence of pulmonary hemorrhage.