摘要
目的探讨新生儿感染性休克与新生儿危重病例评分(NCIS)及新生儿全身炎症反应综合征(SIRS)间的关系。方法根据新生儿休克分度、新生儿危重度评分、新生儿新SIRS诊断标准,对广州市儿童医院1991—2004年收治的感染性休克新生儿117例分别作统计分析。结果(1)117例中以出生3d内发病为多(59.8%),死亡69例,多于入院后3d内死亡(78.3%),原发病主要为败血症,其次为感染性肺炎及坏死性小肠结肠炎。(2)入院当天危重度评分,全部处于危重分值,其中多数患儿处于极危重分值(82.0%)。(3)非SIRS患儿68例,死亡31例,病死率45.6%,伴发SIRS者49例,死亡38例,病死率77.6%,与非SIRS组比较,差异有统计学意义(P<0.01),其中符合项目越多,病死率亦越高。符合SIRS诊断的四项标准中,以体温改变为多,且多表现为体温低下(81.6%),心率改变例数不多(28.6%),主要见于重度休克儿(心率减慢)。白细胞数<5×109/L的12例,均发生于中重度休克,病死率高(75.0%)。结论(1)新生儿感染性休克多发生于出生3d内,NCIS检查能反映病情的严重度,若对可疑病例及早开展CNIS,必能早期发现危重病例。(2)感染性休克与SIRS新诊断标准关系并不密切,SIRS新诊断标准对新生儿重度感染的敏感性低,但伴发SIRS者的病死率明显高于非SIRS者。
Objective To discuss the relationship between neonatal critical illness score (NCIS) and systemic inflammatory response syndrome (SIRS) by studying 177 cases of septic shock neonates. Methods A total of 177 neonates of septic shock were separately evaluated by neonatal shock score, critical score and new neonatal SIRS diagnostic criteria, and the data were under statistic analysis. Results ①Most neonates first suffered from shock in the first 3 days after birth (59. 8% ). Totally 69 cases died,most of whom died in the first 3 days of hospitalization (78.3%). The primary affection mostly was septicemia, secondly were infectious pneumonia and necrotizing enterocolitis. ②On the first day of hospitalization, all cases'critical scores were in critical degree, most of which were in extremely critical degree( 82.0% ).③There were 68 cases without SIRS,in which 31 cases died and the mortality rate was 45.6%. The other 49 cases were incorporated with SIRS,in which 38 cases died and the mortality rate was 77. 6%. The results indicated the mortality in SIRS group was significantly higher than the non-SIRS group (P 〈0. 01). If the neonates had more items in accordance with the diagnostic criteria for SIRS, they would have higher mortality. The most common according item was the change of body temperature,most of which was hypothermia (81.6%). The change of heart rate was not common (28.6%) ,and bradycardia was mainly seen in the severe shock neonates. There were 12 cases'WBC counts 〈5 × 10^9L,all happening in neonates with middle-severe shock, which had a high mortality rate ( 75.0% ). Conclusion ① Neonatal septic shock mostly happens in the first 3 days after birth. NCIS can reflect the degrees of illness in neonates. If we can evaluate the suspicious cases by NCIS earlier, we may find out the severe cases in advance. ②The relationship between septic shock and new SIRS diagnostic criteria is not close. The new SIRS diagnostic criteria have low sensitivity in severe neonatal in-fections. However, the mortality rate of cases with SIRS is significantly higher than the cases without SIRS.
出处
《中国实用儿科杂志》
CSCD
北大核心
2008年第5期359-361,共3页
Chinese Journal of Practical Pediatrics