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目的运用循证方法探讨中国大陆地区新生儿医院感染各部位发生及分布情况。方法系统检索建库至2013年在CNKI、CBM、VIP、Wan Fang data及Pub Med上有关中国大陆地区新生儿医院感染调查的文献,纳入合格研究。根据异质性检验结果,采用合适的模型对原始数据进行合并分析。结果共纳入147篇合格文献,中国大陆地区新生儿院内感染部位分析结果表明:总感染率和总分布率最高部位均为下呼吸道,分别为16‰(95%CI:13‰~19‰)和27%(95%CI:21%~32%)。分组分析结果显示:按医院分类和等级分析,感染率最高部位在综合性医院为下呼吸道21‰(95%CI:17‰~24‰),在专科医院为胃肠道12‰(95%CI:10‰~14‰);在三级、二级及以下等级医院均为下呼吸道15‰(95%CI:12‰~18‰)、18‰(95%CI:13‰~22‰)。按地区分析,感染率最高部位在东部、中部地区医院为下呼吸道16‰(95%CI:12‰~21‰)、17‰(95%CI:12‰~21‰),在西部地区医院为口腔黏膜17‰(95%CI:12‰~21‰)。按时间分析,1985-1999年感染率最高部位为口腔黏膜19‰(95%CI:12‰~27‰),2000-2013年感染率最高部位为下呼吸道17‰(95%CI:13‰-20‰)。结论新生儿医院感染中呼吸道为最常见的感染部位,但不同医院有各自的特殊性,因此每个医院应结合自己的具体情况采取相应措施来预防和减少新生儿院内感染的发生。
Objective To explore the occurrence and distribution of various parts of neonatal hospital infection in mainland China by evidence-based method. Methods The databases of CNKI, CBM, VIP, Wan Fang data and Pub Med on the investigation of neonatal nosocomial infections in mainland China were searched systematically by 2013 and included in the eligible study. According to the result of heterogeneity test, the original data are analyzed by the appropriate model. RESULTS: A total of 147 eligible documents were included. The analysis of neonatal nosocomial infections in Mainland China showed that the highest rates of total infection and total distribution were lower respiratory tract, 16 ‰ (95% CI: 13 ‰ to 19 ‰) and 27% (95% CI: 21% ~ 32%). Group analysis showed that the highest infection rate was 21 ‰ (95% CI: 17 ‰ ~ 24 ‰) in lower respiratory tract in general hospital and 12 ‰ (95% CI : 10 ‰ ~ 14 ‰). In the third, second and lower level hospitals, the lower respiratory tract was 15 ‰ (95% CI: 12 ‰ ~ 18 ‰) and 18 ‰ (95% CI: 13 ‰ ~ 22 ‰). By region, the highest infection rates were reported in 16% of the lower respiratory tract (95% CI: 12% to 21%) and 17% (95% CI: 12% to 21%) in the eastern and central hospitals. Oral mucosa 17 ‰ (95% CI: 12 ‰ ~ 21 ‰). According to the time analysis, the highest infection rate was 19 ‰ (95% CI: 12 ‰ ~ 27 ‰) of oral mucosa from 1985 to 1999. The highest infection rate was 17 ‰ of lower respiratory tract (95% CI: 13 ‰ - 20 ‰). Conclusion The respiratory tract in neonatal hospital infection is the most common site of infection, but different hospitals have their own particularities. Therefore, each hospital should take corresponding measures to prevent and reduce neonatal nosocomial infection.