早产儿脓毒血症早期临床表现

Earlier Clinical Signs of Sepsis in Premature Infants

目的探讨早产儿脓毒血症的早期临床症状,以助早期诊断和治疗。方法将122例临床诊断为脓毒血症的早产儿作为观察组,152例无感染高危因素及感染征象的早产儿作为对照组。记录观察组提示感染的临床表现及出现的时间,同时进行血培养、降钙素原(PCT)及CD64检查。记录2组患儿病程中出现过心率增快、体温升高及血糖波动的总例数。结果观察组最常见的3项首发表现为心率增快(43.4%)、血糖波动(25.4%)、体温升高(17.2%),共占86.1%。2组比较,观察组发生心率增快或体温升高者更多,差异有统计学意义(Pa<0.05)。心率增快对于诊断脓毒血症的灵敏度为72.1%,特异度为73.0%(OR=7.01,95%CI4.11～12.00),而体温升高对于诊断脓毒血症的灵敏度为31.1%,特异度为92.8%(OR=5.79,95%CI 2.81～11.95),二者均为诊断脓毒血症的独立危险因素。2组血糖波动发生率比较无统计学差异(P>0.05),不是独立危险因素。观察组血培养阳性率为27.9%,PCT阳性率为90.4%,中性粒细胞CD64阳性率为95.1%。结论心率增快、体温升高和血糖波动是早产儿脓毒血症的早期临床表现,较传统临床表现更早出现,联合PCT、CD64等检查,可提高脓毒血症的早期诊断率。

Objective To discuss the earlier clinical signs of sepsis in premature infants,in order to assist earlier diagnosis and treatment. Methods The premature infants were assigned as the observational group：122 premature infants with sepsis,and the control group：152 premature infants with no infection.The clinical signs that indicated infection and the time of infection were recorded in the observational group.Meanwhile,the blood culture was made and procalcitonin（PCT） and CD64 were measured in the observational group.The total cases with increased heart rate or temperature,fluctuated blood sugar levels were counted respectively in 2 groups.Comparisons were made between the 2 groups. Results Increased heart rate（43.4%）,increased temperature（17.2%） and fluctuated blood sugar levels（25.4%） were the first three clinical signs which were found in the observational group.The ratios of cases with increased heart rate and temperature were higher in the observational group（Pa0.05）.The sensitivity of increased heart rate was 72.1%,and the specificity was 73.0%（OR=7.01,95%CI 4.11-12.00）.The sensitivity of increased temperature was 31.1%,and the specificity was 92.8%（OR=5.79,95%CI 2.81-11.95）.Both of the two clinical signs described above were served as risk factors for sepsis in premature infants respectively.While fluctuated blood sugar level had no statistic difference between the 2 groups.In the observational group,the positive ratio of blood culture,PCT and CD64 were 27.9%,90.4% and 95.1%. Conclusions Increased heart rate or temperature,fluctuated blood sugar level are the earlier clinical signs of sepsis in premature infants,which are found earlier than those traditional clinical signs.The earlier diagnosis of sepsis could be made if the examination of PCT is combined with CD64 and others.