临床及实验室评估对早产儿医院感染早期诊断的意义

Early diagnosis of the premature infant nosocomial infection by clinical assessment and laboratory examination

目的探讨临床评估及实验室检查对早产儿医院感染早期诊断的价值。方法制定早产儿感染评分表,选择2009年1月至2010年6月在菏泽市立医院新生儿病房住院及2010年7～12月在中国医科大学绍兴医院新生儿科住院的早产儿,在抗生素使用前及治疗5天时根据临床表现进行评分,同时在应用抗生素前进行实验室检查,分为败血症组、非败血症感染组(感染组)、非感染组(对照组),对不同组别、不同评分点评分的差异、临床表现、实验室检查的特异度、敏感度、误诊率、漏诊率、正确率、阳性似然比、阴性似然比进行统计学分析。结果败血症组(27例)初始评分最高(16.2±7.2)分,感染组(39例)其次(12.4±5.3)分,对照组(52例)最低(5.3±3.2)分,3组间差异有统计学意义(P<0.05);败血症组和感染组治疗后评分明显下降(7.3±3.9)分和(6.7±3.5)分,与对照组(5.2±3.0)分比较差异无统计学意义(P>0.05)。临床表现中反应低下、喂养困难、体温异常、皮肤循环差等对诊断有重要的预测价值,其中反应低下诊断价值最高;抗生素使用前的CRP和PCT阳性似然比较高(66.8%和72.5%),诊断价值最高,PLT有一定诊断价值。结论对早产儿进行临床评估是发现医院感染的基础,常规的实验室检查有助于早产儿医院感染的早期诊断。

Objective To explore the diagnostic value of clinical assessment and laboratory examination in early premature infant nosocomial infection.Methods Premature infants were assigned into three groups：septic group,non-septic infected group（infected group） and non-infected group（control group）,based on the current diagnostic criteria for newborns.We scored the severity of their illness based on clinical manifestations and compared the scores before and after antibiotic treatment after 5 days.Sensitivity,specificity,false positive rate,false negative rate,correct rate,positive likelihood ratio and negative likelihood ratio were calculated for each test.Results Severity scores were significantly different among the three groups [（16.2±7.2） vs.（12.4±5.3） vs.（5.3±3.2）,P0.05] before treatment.Before treatment,septic group（n=27） scored the highest,control group（n=52） the lowest.After antibiotic treatment,scores in septic group and infected group significantly decreased [（7.3±3.9） and（6.7±3.5）,P0.05],and they were not significantly different compared to the control group（P0.05）.Among all,abnormality in response,feeding,temperature and skin circulation were important value for diagnosis,with abnormal response the highest positive likelihood ratio.Among laboratory examinations before treatment,CRP and PCT had a higher positive likelihood ratio and the highest diagnostic value.PLT had some value in diagnosis.Conclusions Clinical assessment in premature infants are the basis for septic diagnosis.Current laboratory examinations have the advantages in the estimation of infection possibility.