产后脓毒血症危险因素分析

来源 :中国医师进修杂志 | 被引量 : 0次 | 上传用户:cntanmingyong
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目的:探讨产后发生脓毒血症的相关危险因素,为临床预防产后脓毒血症的发生提供参考依据。方法:采用回顾性分析方法,选取2016年1月至2018年12月于中国医科大学附属盛京医院就诊并生产的产后患者为研究对象,选取99例产后患脓毒血症患者作为病例组,应用简单随机方法选取同期不伴有产后脓毒血症患者212例作为对照组,通过查阅医院电子病历系统对两组患者的临床资料进行收集整理,采用单因素、多因素Logistic回归分析产后脓毒血症的危险因素。结果:99例产后脓毒血症患者的感染部位主要为生殖道、呼吸系统,分别占28.28% (28/99)、26.26%(26/99);99例产后脓毒血症患者血培养检出病原菌以革兰阳性菌比例最高,占58.59%(58/99),其中以链球菌为主,占23.23%(23/99)。革兰阴性菌占38.38%(38/99),其中以大肠埃希菌为主,占31.31%(31/99);多因素Logistic回归分析显示,妊娠期糖尿病(n OR=2.643,95% n CI 1.123 ~ 6.276)、合并生殖道感染(n OR=7.542,95% n CI 3.571 ~ 15.959)、阴道试产(转剖宫产)(n OR=1.218,95% n CI 1.008 ~ 1.493)、胎膜早破(n OR=1.152,95% n CI 1.019 ~ 1.449)、产后出血(n OR=1.562,95% n CI 1.263 ~ 1.881)及剖宫产分娩(n OR=2.074,95% n CI 1.442 ~ 2.993)是产后脓毒血症的危险因素。n 结论:影响产后脓毒血症的主要危险因素有妊娠期糖尿病、合并生殖道感染、阴道试产(转剖宫产)、胎膜早破、产后出血及剖宫产分娩,针对危险因素在临床治疗过程中要加强预防,采取相应干预措施,对防治产后脓毒血症有重要意义。“,”Objective:To explore the risk factors of postpartum sepsis and provide references for clinical prevention of postpartum sepsis.Methods:The clinical data of postpartum patients who were treated and delivered in the maternity ward of Shengjing Hospital Affiliated of China Medical University from January 2016 to December 2018 were analyzed retrospectively. Among them, 99 patients with postpartum sepsis were assigned to the case group and 212 patients without postpartum sepsis in the same period were selected with a simple random method and as the control group. The clinical data of the two groups were collected by consulting the hospital electronic medical record system. Single factor and multivariate Logistic regression were applied to analyze the risk factors of postpartum sepsis.Results:The infection sites of 99 postpartum sepsis patients were mainly genital tract and respiratory system, accounting for 28.28% (28/99) and 26.26% (26/99), respectively. In blood culture of 99 cases of postpartum sepsis patients, 58.59% (58/99) pathogens of Gram-positive bacteria were detected with the highest proportion, among which Streptococcus was mainly, accounting for 23.23%(23/99). The proportion of Gram-negative bacteria was 38.38%(38/99), and Escherichia coli was mainly, accounting for 31.31% (31/99). Multivariate Logistic analysis showed that gestational diabetes (n OR = 2.643, 95% n CI 1.123 - 6.276), genital tract infection (n OR = 7.542, 95% n CI 3.571-15.959), vaginal trial (switch to cesarean section) (n OR = 1.218, 95% n CI 1.008-1.493), premature rupture of membranes (n OR = 1.152, 95% n CI 1.019 - 1.449), postpartum hemorrhage (n OR = 1.562, 95%n CI 1.263 -1.881) and cesarean delivery (n OR = 2.074, 95% n CI 1.442 - 2.993) were the risk factors of postpartum sepsis.n Conclusions:The main risk factors affecting postpartum sepsis includes gestational diabetes, genital tract infection, vaginal trial (switch to cesarean section), premature rupture of membranes, postpartum hemorrhage and cesarean delivery. It is necessary to take corresponding intervention measures to strengthen prevention of these risk factors, which is of great significance for prevention and treatment of postpartum sepsis.
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