新生儿重症感染合并毛细血管渗漏综合征11例临床分析

Clinical analysis on 11 neonates of severe infectious disease complicated with capillary leak syndrome

目的探讨新生儿重症感染合并毛细血管渗漏综合征（capillary leak syndrome，CLS）的临床特点、治疗措施及死亡原因。方法回顾性分析我院NICU2009年1月至2010年7月收治的11例新生儿重症感染合并CLS患儿的临床表现、辅助检查、治疗措施及转归。结果11例患儿中，原发病为肺炎5例，脓毒症6例；均出现进行性皮肤黏膜水肿、呼吸困难、不同程度感染性休克、尿少、低白蛋白血症（10～20g／L）。在控制感染、抗休克、机械通气、对症治疗及维持内环境稳定的基础上，早期应用羟乙基淀粉10～15ml／kg，每8～12小时给药，交替应用血浆、白蛋白，同时应用利尿剂，最终抢救成功6例；其中4例发育良好、智力及运动能力正常，1例头颅CT示脑积水，1例双下肢肌张力偏高。死亡5例。结论CLS是新生儿重症感染的严重并发症，病死率高，早期在综合治疗基础上给予羟乙基淀粉可提高抢救成功率。

Objective To investigate the clinical features,treatment and the causes of death in severe infectious disease complicated with capillary leak syndrome （CLS） in neonates. Methods The clinical data,laboratory finding,treatment and clinical outcome of 11 neonates who had severe infectious disease complicated with CLS in our NICU from Jan 2009 to Jul 2010 were collected and analysed retrospectively. Results Among the 11 neonates,five had pneumonia and the other six had sepsis. All the 11 cases appeared progressive edema on skin and mucosa, dyspnoea, infective shock, oliguria and hypoalbuminemia （ 10 - 20 g/L）. We treated the 11 cases with hydroxyethyl starch（ 10 - 15 ml/kg,every 8 to 12 h） at early stage on the basis of infection con- trol, anti-shock treatment, mechanical ventilation, symptomatic treatment and a stable internal environment. At last,6 cases were rescued,in whom 4 cases were well-developed, had normal intelligence and athletic ability, the other two cases had hydrocephalus or muscle tone high of both lower extremities. Five cases died. Conclusion CLS is a severe complication of neonatal severe infection, and had high mortality. Treating with hydroxyethyl starch at an early stage can increase the survival rate.