新生儿肺炎的病原及临床研究

Study on Pathogen and Clinical Characteristics of Infectious Pneumonia in Neonates

目的 研究新生儿肺炎的病原和临床特点。方法 呼吸道分泌物细菌培养 ;肺炎支原体 (MP)及沙眼衣原体 (CT)荧光核酸检测 ;直接免疫荧光法检测呼吸道合胞病毒 (RSV) ,流感病毒A、B型 ,副流感病毒 1、 2、 3型 ,腺病毒。结果 474例新生儿肺炎中病原检测阳性 14 8例 (3 1 2 % ) ;其中细菌性病原 93例 (62 8% ) ,RSV肺炎 40例 (2 7 0 % ) ,副流感病毒 3型 3例 (2 0 % ) ,CT肺炎 11例 (7 4% ) ,MP 1例(0 7% )。阴性 3 2 6例 (68 8% )。G- 杆菌占细菌总数的 80 6% ,G+ 球菌占 19 4%。早产儿 (胎龄 <3 7W)、足月儿 (胎龄≥ 3 7W)、早期新生儿 (≤ 7d)、晚期新生儿 (>7d) ,G- 杆菌的检出率显著高于G+ 球菌 (P <0 0 5 )。不同胎龄、日龄儿G- 杆菌与G+ 球菌的检出率无显著性差异 (P >0 0 5 )。RSV肺炎发病季节在 12月～ 5月底。临床表现为喘憋及肺部喘鸣音。CT肺炎阴道分娩占 90 9% ,剖宫产仅 9 1%。结论 新生儿肺炎临床症状不典型 ,难以依靠临床表现作出病原诊断。RSV肺炎是新生儿病毒性肺炎最常见的病原。

Objective To study the pathogen and clinical characteristics of infectious pneumonia in neonates. Methods The secretions from respiratory tract were cultured, which were analyzed by fluorescent detection from nucleic acid to identify mycoplasma pneumonia (MP) and chlamydia trachomatis (CT) and direct immunofluorescence detection to identify respiratory syncytial virus (RSV), influenzavirus A and B, parainfluenza virus and adenovirus. Results The total positive rate were 31.2% (148 of 474 cases), among which the pathogens were bacterium in 93 cases (62.8%) with G - bacilli 80.6% and G + cocci 19.4%, RSV in 40 cases(27.0%), CT in 11 cases (7.4%), parainfluenza type 3 in 3 cases (2.0%), and MP in 1 cases(0.7%), respectively. In premature group (gestational age<37w), mature group (gestational age≥37w), early stage neonate group (≤7d) and later stage neonate group (>7d), the detection rates of G- bacilli were significantly higher than those of G+ cocci (P<0.05). As for RSV infection, the episode rose during the course of December in the year and May in next year, and its main symptoms were asthma suppress and wheeze. As for CT pneumonia, vaginal delivery accounted for 90.9%. Conclusion The clinical symptoms of neonatal pneumonia are not typical, from which it is difficult to identify the pathogens. RSV infection is the most common viral pathogen in neonates' pneumonia.