新生儿感染性肺炎病原学检测及临床研究

Pathogen detection and clinical study of infectious pneumonia in the newborn

目的了解昆明地区新生儿感染性肺炎的病原学、流行病学及临床表现特点。方法选择506例确诊新生儿感染性肺炎住院患儿为观察组及50例非新生儿感染性肺炎住院患儿为对照组,对两组病例取呼吸道分泌物做细菌及病毒病原学检测,将检测结果与临床相关因素进行分析总结。结果对照组呼吸道病毒病原学检测均为阴性,为非病原菌生长。观察组呼吸道病原学阳性检出率为58·7%,其中细菌培养阳性占35·18%,以大肠埃希菌为主;病毒占23·3%,以呼吸道合胞病毒多见;结核感染占0·2%;病原不明者41·3%。新生儿感染性肺炎以出生后感染居多,占89·33%,而宫内感染性肺炎仅占10·67%。新生儿细菌感染性肺炎患儿咳嗽(χ2=10·20,P<0·01),感染中毒症状(χ2=8·21,P<0·01)、双肺湿罗音(χ2=6·11,P<0·05)及缺氧征(χ2=8·21,P<0·05)明显多见于病毒感染;而病毒感染者冬春季明显多于夏秋季。结论新生儿感染性肺炎58·70%可明确病原,细菌感染多于病毒感染;感染性肺炎以出生后多见;细菌感染与病毒感染各有其临床特点。

Objective To study the pathogens, epidemiology and clinical characteristics of neonatal infectious pneumonia in the newborn in kunming. Methods Five hundred and six admitted newborns with confirmed infectious pneumonia were included in the pneumonia group, and 50 admitted newborns with non-infectious pneumonia were included in control group. Their respiratory tract secretions were obtained for bacterial and viral studies. The results and relevant clinical factors were then analyzed. Results In control group, viral cultures （tests） were negative and few cultures positive for pathogens. In pneumonia group, 58.7% was positive for pathogens, among which, 35.2% bacteria （mainly Escherichia coli ）, 23.2% viruses [ mainly respiratory syncytial virus （ RSV ） ], 0. 2% tuberculosis bacilli, and 41.3% unknown pathogens. 89.3% of infectious pneumonia occurred postnatally, only 10. 7% occurred prenatally. Among the cases of bacterial pneumonia, the occurrence of cough （x^2 = 10. 20, P 〈 0. 01 ）, rales bilaterally （x^2 = 6. 11, P 〈 0. 05 ）, toxic appearance （x^2 = 8.21, P 〈 0. 01 ） and hypoxia （x^2=8.21 ,P 〈0. 05） were higher than those of viral pneumonia. Viral pneumonia was more common in winter and spring. Conclusions 58.7% neonatal infectious pneumonia has cinfirmed, pathogens. Bacterial infection is more common than viral infection. Most infections are acquired after birth. Bacterial and viral infection in neontes have different clinical manifestations.