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中华妇幼临床医学杂志(电子版) ›› 2014, Vol. 10 ›› Issue (06) : 737 -741. doi: 10.3877/cma.j.issn.1673-5250.2014.06.008

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论著

足月儿和晚期早产儿出生早期呼吸困难的不同抗菌药物使用策略研究
夏斌1, 胡勇1, 李晋辉1, 伍金林1,*,*()   
  1. 1. 610041 成都,四川大学华西第二医院儿科
  • 收稿日期:2014-11-13 修回日期:2014-11-18 出版日期:2014-12-01
  • 通信作者: 伍金林

Study of Different Antibiotic Treatment Strategies on Full Term and Late Preterm Newborn Infants With Dyspnea

Bin Xia1, Yong Hu1, Jinhui Li1, Jinlin Wu1()   

  1. 1. Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
  • Received:2014-11-13 Revised:2014-11-18 Published:2014-12-01
  • Corresponding author: Jinlin Wu
  • About author:
    (Corresponding author : Wu Jinlin, Email : )
引用本文:

夏斌, 胡勇, 李晋辉, 伍金林. 足月儿和晚期早产儿出生早期呼吸困难的不同抗菌药物使用策略研究[J/OL]. 中华妇幼临床医学杂志(电子版), 2014, 10(06): 737-741.

Bin Xia, Yong Hu, Jinhui Li, Jinlin Wu. Study of Different Antibiotic Treatment Strategies on Full Term and Late Preterm Newborn Infants With Dyspnea[J/OL]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2014, 10(06): 737-741.

目的

探讨将抗菌药物使用策略,由临床风险评估策略转变为风险评估结合感染筛查及监测策略,对出生早期有呼吸困难的足月新生儿和晚期早产儿抗菌药物使用率及治疗结局的影响。

方法

采用队列研究方法,选择2009年7月至2013年6月在四川大学华西第二医院新生儿科住院治疗的1 712例合并呼吸困难的新生儿为研究对象。按照住院时间将其分为:研究组(n= 776,住院时间为2011年7月至2013年6月)及对照组(n=936,住院时间为2009年7月至2011年6月)。对照组新生儿仅按照风险评估结果进行抗菌药物治疗,而研究组则按照风险评估结合感染筛查及监测结果进行抗菌药物治疗。对两组患儿抗菌药物使用率、再入院率、平均住院日及感染相关不良事件等进行统计学分析。两组患儿入院时年龄及性别构成比比较,差异均无统计学意义(P>0.05)。本研究遵循的程序符合四川大学华西第二医院人体试验委员会制定的伦理学标准,得到该委员会批准,分组征得患儿家属知情同意,并与家属签署临床研究知情同意书。

结果

两组均无死亡病例。①研究组抗菌药物使用率较对照组显著降低,且差异有统计学意义(P<0.01)。②两组患儿再入院率及平均住院日比较,差异均无统计学意义(P>0.05)。③两组患儿医院获得性感染、感染性肺炎、败血症、坏死性小肠结肠炎等与感染相关的不良事件发生率比较,差异亦均无统计学意义(P>0.05)。

结论

根据风险评估结合感染筛查及监测结果制定抗菌药物使用策略,可明显降低出生早期有呼吸困难足月新生儿和晚期早产儿的抗菌药物使用率,且不会对患儿产生不良影响。

Objective

To observe the antibiotic use rate and outcomes of full term and late preterm newborn infants complicated with dyspnea who were managed with two different antibiotics treatment strategies, namely, the clinical risk factors based antibiotic treatment strategy and combination antibiotic treatment strategy that is based on clinical risk factors, infection screening,and monitoring.

Methods

A cohort study was made with 1 712 newborn infants complicated with dyspnea signs who hospitalized in neonatal ward in West China Second University Hospital,Sichuan University from July 2009 to June 2013. According to hospitalization time periods,they were divided into study group of 776 cases(from July 2011 to June 2013) and control group of 936 cases (from July 2009 to June 2011). The control group adopted the clinical risk factors based antibiotic treatment strategy and the study group received a combination antibiotic treatment strategy based on clinical risk factors, infection screening, and monitoring. Antibiotic use rate, readmission rate, average hospitalization days and infection related adverse events of two groups were statistically analyzed. The age on admission and constituent ratio of gender between two groups had no statistically significant differences(P>0.05). The study protocol was approved by the Ethical Review Board of Investigation in Human Being of West China Second University Hospital,Sichuan University. Informed consent was obtained from the parents of each participant.

Results

There were no death case in two groups.①The antibiotic use rate of study group was significantly lower than that of control group, and the difference was statistically significant ( P < 0.01).② There were no statistically significant differences between two groups in readmission rate and average hospitalization days (P > 0.05).③ There were no statistically significant differences between two groups in incidence rate of infection related adverse events, such as acquired character infection in hospital,bacterial pneumonia, septicemia and necrotizing enterocolitis (P> 0.05).

Conclusions

The combination antibiotic treatment strategy based on clinical risk factors, infection screening,and monitoring can reduce antibiotic use rate for full term and late preterm newborn infants with dyspnea,and have no harmful effects on them.

图1 研究组抗菌药物使用策略流程图
Figure 1 Flow chart of antibiotic treatment strategy of research group
表1 两组患儿入院时一般临床资料比较(±s)
Table 1 Comparison of general clinic data of two groups on admission(±s)
表2 两组患儿抗菌药物使用率及治疗结局比较[n(%)]
Table 2 Comparison of antibiotics use rate and outcomes of two groups[n(%)]
表3 两组患儿感染相关不良事件发生率比较[n(%)]
Table 3 Comparison of infection related adverse events of two groups[n(% )]
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