层流洁净新生儿重症监护病房早产儿实施床旁手术的可行性分析

Feasibility of bedside operation for premature infants in laminar flow clean neonatal intensive care unit

摘要:

目的 探讨层流洁净新生儿重症监护病房(NICU)早产儿实施床旁手术的效果与可行性。 方法 回顾性分析某军队三甲综合医院2017年9月—2020年10月NICU住院并进行床旁动脉导管扎闭术(PDA)及腹部探查术的危重新生儿的临床资料，在NICU行床旁手术者列为NICU组，转入手术室进行手术者列为手术室(OR)组，比较两组新生儿术后体温、切口感染率及病死率的差异。 结果 共计纳入258例新生儿，其中NICU组166例，OR组92例。NICU组新生儿出生胎龄、出生体质量、手术时体质量、新生儿危重病例评分均低于OR组；NICU组新生儿术前应用呼吸机通气比例高于OR组，差异均有统计学意义(均P＜0.05)。NICU组与OR组新生儿术中抽检空气培养微生物菌落数、术前体温、PDA与剖腹探查术的构成比例、术后切口感染发病率及病死率比较，差异均无统计学意义(均P＞0.05)，但手术后OR组新生儿平均体温低于NICU组，差异有统计学意义(P＜0.05)。 结论 层流洁净NICU早产儿行床旁PDA和腹部手术临床可行，且床旁手术更有利于减少术后低体温的发生。对层流洁净病房进行日常规范化维护，可以有效保障危重早产儿床旁手术的安全。

Abstract:

Objective To explore the effect and feasibility of bedside operation for premature infants in laminar flow clean neonatal intensive care unit (NICU). Methods Clinical data of critically ill neonates who underwent bedside ligation of patent ductus arteriosis (PDA) and exploratory laparotomy in NICU of a tertiary first-class army general hospital from September 2017 to October 2020 were analyzed retrospectively, neonates who underwent bedside operation in NICU were classified as NICU group and those who transferred to operating room were classified as operating room group (OR group), differences in post-operative body temperature, incisional infection rate and mortality between two groups of neonates were compared. Results A total of 258 neonates were included, 166 in NICU group and 92 in OR group. Gestational age, birth weight, body weight during operation and neonatal critical illness score in neonates in NICU group were all lower than those in OR group; the proportion of ventilation through ventilator in neonates in NICU group was higher than that in OR group, differences were both statistically significant (both P < 0.05). There were no significant difference in microbial colony count of air culture of intra-operative air samples, pre-operative body temperature, constitute ratio of PDA and exploratory laparotomy, as well as incidence of post-operative incisional infection and mortality between NICU group and OR group (all P>0.05), but the post-operative average body temperature of neonates in OR group was lower than that in NICU group (P < 0.05). Conclusion Premature neonates in laminar flow clean NICU undergoing bedside PDA and abdominal operation is clinically feasible, and bedside operation is more conducive to reducing the occurrence of post-operative hypothermia. Routine standardized maintenance of laminar flow clean ward can effectively ensure the safety of bedside operation for critically ill premature neonates.