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目的分析阴道试产中转剖宫产手术术后产褥感染的影响因素、病原微生物及其耐药性,探讨预防及治疗方法。方法回顾分析经阴道试产失败中转行剖宫产手术终止妊娠的718例产妇及术后发生产褥期感染的31例产妇的临床资料。对产褥期感染患者均行支原体、衣原体、宫颈分泌物培养,高热寒颤者同时行血培养,对呼吸道感染症状者行咽拭子、痰液培养,对尿路感染症状者行尿液培养,对细菌培养结果及病原微生物耐药性进行分析。结果产褥感染与妊娠并发症、低蛋白血症、贫血、阴道炎、胎膜早破、产后出血、阴道试产时间、中转剖宫产时宫口扩张程度以及是否围术期抗炎用药相关。产褥感染的微生物主要来源于阴道及肠道,阴道微生物以支原体为主,均对原始霉素、交沙霉素、强力霉素、四环素敏感。肠道细菌为大肠杆菌及粪肠球菌,均对哌拉西林他唑巴坦敏感。结论加强孕期保健、治疗妊娠合并症、提高产科质量、加强院感管理和严格围术期用药可降低产褥感染的发生。对阴道试产中转剖宫产产妇发生产褥感染者,抗生素应首选哌拉西林他唑巴坦,合并支原体感染者同时口服交沙霉素或强力霉素。
Objective To analyze the influencing factors of puerperal infection, pathogenic microorganisms and their drug resistance after cesarean delivery in vaginal trial production and to explore the methods of prevention and treatment. Methods The clinical data of 718 pregnant women with vaginal delivery failure and 31 pregnant women with postpartum puerperal infection who underwent cesarean section termination of pregnancy were retrospectively analyzed. Patients with puerperal infection were treated with mycoplasma, chlamydia, cervical secretions, fever and tremor at the same time, blood culture, respiratory symptoms were throat swabs, sputum culture, urinary tract infection symptoms of urine culture, the bacteria Culture results and analysis of pathogenic microorganism resistance. Results The puerperal infection was associated with complications of pregnancy, hypoproteinemia, anemia, vaginitis, premature rupture of membranes, postpartum hemorrhage, vaginal trial time, the degree of cervical dilatation during cesarean section and whether perioperative anti-inflammatory medication . Puerperal infection of microorganisms mainly from the vagina and intestine, vaginal microorganisms Mycoplasma-based, are pristinamycin, josamycin, doxycycline, tetracycline-sensitive. Intestinal bacteria Escherichia coli and Enterococcus faecalis, are sensitive to piperacillin and tazobactam. Conclusions Strengthening pregnancy care, treating pregnancy complications, improving obstetric quality, strengthening nosocomial management and strict perioperative medication can reduce the occurrence of puerperal infection. On the vaginal trial of cesarean delivery in pregnant women with puerperal infection, antibiotics should be preferred piperacillin tazobactam, patients with mycoplasma infection oral josamycin or doxycycline.