摘要
目的:观察新生儿重症监护病房(NICU)内32周以下早产儿败血症的危险因素、病原分布,为临床提供诊疗依据。方法:收集2016-2018年本院早产儿的临床资料进行统计分析。纳入患儿分为败血症组及对照组;根据有无早发型败血症(EOS)分为EOS组及NEOS组;发生晚发型败血症(LOS)者为LOS组。结果:①共纳入患儿389例,败血症患儿221例(56.81%)。败血症组平均胎龄与平均出生体质量均显著低于对照组(P<0.01),胎膜早破、宫内感染、窒息发生率显著高于对照组,应用有创性通气及中心静脉置管的比例亦显著高于对照组(P<0.01)。②患儿的临床表现均以少吃少哭少动、病理性黄疸、发绀、喂养不耐受最为多见。EOS组患儿少吃少哭少动、病理性黄疸、发绀、喂养不耐受发生率高于LOS组,LOS组患儿发热、皮肤感染发生率高于EOS组。③EOS组血白细胞计数(WBC)、中性粒细胞绝对值(ANC)、C反应蛋白(CRP)及降钙素原(PCT)水平显著高于NEOS组,血白蛋白(ALB)及球蛋白水平显著低于NEOS组(P<0.01)。LOS患儿起病后血浆ALB水平较起病前明显下降(P<0.05),CRP及PCT水平明显升高(P<0.05)。④检出病原菌70株(G+菌18株,G—菌46株,真菌6株)。G+菌对青霉素类均耐药,对红霉素、庆大霉素大部分耐药。G-菌对氨苄西林均耐药,对加酶青霉素类及四代头孢菌素敏感性较高。除部分铜绿假单胞菌,G-菌株对亚胺培南、美罗培南、氨基糖苷类抗生素均敏感。结论:32周以下早产儿败血症发病率及病死率明显高于足月儿。小胎龄、低出生体质量、胎膜早破、宫内感染、围产期窒息、有创机械通气及中心静脉置管均为高危因素。临床表现不典型,血培养阳性率低,主要依靠非特异性指标诊断。G—菌仍为NICU内的主要病原菌,大部分病原菌存在多重耐药。抗生素种类及疗程的合理选择对病原菌谱、耐药性及患儿近远期预后至关重要。
Objective:To explore the clinical features and pathogens of neonatal septicemia in preterm infant under 32 weeks.Methods:The clinical data of preterm infant were analyzed retrospectively.The infants were devided into different groups according to the types of septicemia.Results:Among the 389 patients involved,there were 221 patients with sepsis.There were significant differences between control group and septicemia group in risk factors including birth weight,gestational age,premature rupture of membranes,intrauterine infection,asphyxia,mechanical ventilation,central venipuncturation.Clinical symptoms such as cyanosis,feeding intolerance,neonatal jaundice,fever,and pustule also showed differences between the two groups.Neonates in the EOS group had significantly higher levels of WBC count,ANC,CRP and PCT than in NEOS group,as well as lower levels of serum ALB and GLB.The level of ALB was significantly lower than before,while CRP and PCT levels significantly increased.There were 70 pathogens detected in 58 infants.The G+bacteria were generally resistant to penicillins,mostly resistant to erythromycin,clindamycin and gentamicin,but showed susceptibility to vancomycin and linezolid.All of the G-bacteria were resistant to ampicillin,and were partly resistant to the second and third generation cephalosporins.Conclusion:The preterm infants under 32 weeks were more susceptible to septicemia than full-term infants.Small gestational age,low birth weight,perinatal infection,perinatal asphyxia,invasive treatment were all risk factors.The early diagnosis depends mainly on the nonspecific index.Gram-negative bacteria were still the main pathogens in NICU,and most of the pathogens are multidrug-resistant.Appropriate antimicrobial therapy is very important on the distribution and constitution of pathogens and prognosis of infants.
作者
樊盼盼
郑君文
魏聪
汪霞
杨璞
赵东赤
FAN Panpan;ZHENG Junwen;WEI Cong;WANG Xia;YANG Pu;ZHAO Dongchi(Dept.of Pediatrics,Zhongnan Hospital of Wuhan University,Wuhan 430071,Hubei,China)
出处
《武汉大学学报（医学版）》
CAS
2020年第1期101-105,共5页
Medical Journal of Wuhan University
基金
国家自然科学基金资助项目(编号:81670007).
关键词
早产儿
早发型败血症
晚发型败血症
Preterm Infant
Early Onset Septicemia
Late Onset Septicemia
