新生儿侵袭性真菌感染11例临床观察

Clinical observation of 11 cases of neonatal invasive fungal infection

目的 探讨新生儿侵袭性真菌感染(IFI)的临床特点.方法 回顾分析我院新生儿重症监护室11例确诊为IFI患儿的临床特点、易感因素及治疗转归.结果 11例侵袭性真菌感染患儿中,真菌性败血症8例,真菌性肺炎3例；10例为早产儿,9例出生胎龄＜34周,7例为极低出生体重儿,ll例IFI起病前均曾接受静脉应用广谱抗生素、营养支持及持续静脉内留置针,2例留置中心静脉导管,7例曾机械通气.入院后7～10天出现反应差、反复青紫伴呼吸暂停、喂养不耐受、四肢松软、肤色苍灰、低血压及发热等症状,8例血小板减少.血培养白假丝酵母菌5例,近平滑假丝酵母菌3例；痰培养3例均为白假丝酵母菌.感染后11例患儿均接受抗真菌及对症支持治疗,10例治愈后出院,l例放弃治疗.结论 IFI的高危因素包括早产儿、长期应用广谱抗生素、持续静脉内留置导管、机械通气等,症状往往不典型,常伴有血小板计数下降.早期诊断及早期治疗预后较好.

Objectives To observe the clinical features of neonates with invasive fungal infections in the neonatal intensive care unit of the hospital.Methods A retrospective analysis of the clinical features,predisposing factors and treatment experience in 11 cases of invasive fungal infections was conducted.Results All of 11 cases,10 cases was premature children,9 cases with gestational age of less than 34 weeks,7 cases very low birth weight infants,2 cases treated with peripherally inserted central catheter(PICC)and 7 cases supported by mechanical ventilation(IMV).All cases were receiving intravenous broad-spectrum antibiotics,parenteral nutrition and continuous intravenous catheter.From 7 days to 10 days after admission,there were a number of clinical symptoms such as poor response,cyanosis,apnea,feeding intolerance,soft limbs,skin color pale gray,low blood pressure,fever and so on.Blood culture ahowed candida albicans(5 cases),and nearly smooth candida yeast(3 cases).All cases accepted anti-fungal,supportive and symptomatic treatment.Ten patients were cured and discharged,and only one patient gave up treatment.Conclusion Neonatal high risk factors for invasive fungal infections were premature birth,long-term application of broad-spectrum antibiotics,continuous intravenous catheter and IMV.The clinical symptoms were often atypical,accompanied by a decrease in platelet count.The prognosis would be favorite if early diagnosis and early treatment were given.