新生儿呼吸道合胞病毒下呼吸道感染75例分析

Analysis of 75 eases lower respiratory tract infection by respiratory syncytial virus

目的总结新生儿呼吸道合胞病毒（respiratory syncytial virus, RSV）下呼吸道感染的临床特点。方法回顾性分析20lO年1月至12月人住本院新生儿科的75例RSV下呼吸道感染患儿的病例资料，分析其临床表现、辅助检查、治疗及预后特点。采用卡方检验分析影响住院时间的高危因素。结果2010年1月至12月，本院新生儿科临床诊断为下呼吸道感染的新生儿共3,54例，其中RSV下呼吸道感染75例，占21．2％。发病13龄5～25d，平均13．2d，其中早产儿2例（2．7％）。均以咳嗽为主要临床表现（100．0％，75／75），其次为气促（56．0％，42／75）、口吐泡沫（52．0％，a9／75）、发热≥38．0℃（25．3％，19／75）等。75例患儿中1例患儿WBC≥20．0×10^9／L；淋巴细胞比值增高（〉0．48）者52例，占69．3％；血D反应蛋白≥8mg／I，者8例，占10．7％。58例患儿进行血气分析检查，28例患儿出现不同程度的二氧化碳潴留（二氧化碳分压≥45mmHg），占48．3％。75例患儿入院48h内拍摄胸片，提示新生儿肺炎39例，占52．0％；提示支气管炎15例，占20．0％。69例患儿行痰培养检查，20例阳性。11例行血培养检查，检出表皮葡萄球菌3例。73例治愈出院，2例好转出院，无一例死亡。患儿平均住院8．4d（3～17d）。C-反应蛋白≥8mg／L、二氧化碳分压≥45mrnHg、需要鼻导管吸氧及辅助通气（经鼻持续气道正压通气和机械通气）者住院时间≥7d的比例较高。结论新生儿RSV下呼吸道感染较婴幼儿临床症状不典型，主要以咳嗽、气促、口吐泡沫为主，喘憋、肺部哮呜音少见。目前尚无有效的治疗方法，主要以加强支持治疗为主。

Objective To summarize the clinical features of neonatal lower respiratory tract infection of respiratory syncytial virus （RSV）. Methods Data of newborns admitted into Department of Neonatology of Yuying Children Hospital of Wenzhou Medical College froru January to December 2010 with RSV lower respiratory tract infection were retrospectively analyzed. The characteristics of clinical manifestation, examination, treatment and prognosis were studied. Factors affecting the duration of hospitalization were analyzed with X2 test. Results Of 354 cases of neonatal lower respiratory tract infection, 75 （21.2%） were RSV positive, whose attack time was from 5 to 25 days with an average of 13.2 days; and there were two preterm infants （2.7%）. The chief clinical manifestations were cough （100.0%, 75/75）, followed by shortness of breath （56.0%, 42/75）, spittle （52.0%, 39/75） and fever with temperature -38.0℃ （25.3%, 19/75）. The white blood cell count of one newborn was higher than 20.0×10^9/L; 52 cases （69.3 %） had higher blood lymphocyte percentage （≥ 0.48） ; eight cases （10.7%） had higher level of C-reactive protein （≥8 mg/L）. Among the 58 patients who underwent blood gas analysis, 28 （48.3%） had carbon dioxide retention （partial pressure of carbon dioxide≥45 mm Hg）. Chest X-ray results within 48 hours after hospitalization suggested that 52.0% patients （n=39） had pneumonia and 20.0% （n=15） had bronchitis. Among 69 patients who had sputum cultures, 20 cases were positive. And for the 11 cases who had blood cultures, three were positive for Staphylococcus epidermidis. Finally, 73 cases were cured, two were improved and no death was reported. The duration of hospitalization was from 3 to 17 days with an average of 8.4 days. Neonates with RSV lower respiratory tract infection who had higher C-reactive protein （≥8 mg/L）, carbon dioxide retention, nasal oxygen catheter or assisted ventilation had higher percentage of longer hospital stay （≥7 days）. Conclusions Compared with infants, the clinical characteristics of RSV lower respiratory tract infections in neonates are atypical, which are mainly menifested by cough, shortness of breath, spittle, but rare wheezing. There are no effective interventions against RSV infection except for supportive therapy.