不同病原菌所致新生儿败血症的临床研究

The clinical characteristics of neonatal sepsis caused by different pathogens

目的探讨革兰阳性(G+)菌、革兰阴性(G-)菌和真菌所致的新生儿败血症的特点,以提高识别能力,使早期经验性治疗更准确。方法对2009年1月至2011年12月新生儿重症监护病房收治的符合诊断标准的226例新生儿败血症进行回顾性分析。结果 G+菌检出率50.9%;G-菌检出率为35.0%;真菌检出率为14.1%。G-组、G+组多见于胎龄和出生体质量较大的新生儿,真菌组多见于早产/低出生体质量儿,且院内感染比例高,三组间胎龄、出生体质量、院内感染发生率的差异均有统计学意义(P均<0.05);G-组胎膜早破>18 h、羊水Ⅲ度污染者较G+组和真菌组多,差异有统计学意义(P<0.05);G-组早发型败血症高于G+组和真菌组,差异有统计学意义(P<0.05)。真菌组发热较G-组、G+组少,发生频繁呼吸暂停较G-组、G+组多,差异均有统计学意义(P均<0.05)。G-组、G+组血白细胞计数升高程度高于真菌组,差异有统计学意义(P<0.05);三组血小板计数均下降,但差异无统计学意义(P>0.05)。真菌组住院时间长于G+组和G-组,差异有统计学意义(P<0.05);三组治愈率和病死率差异无统计学意义(P>0.05)。结论不同病原菌所致新生儿败血症的一般情况、临床表现、感染指标变化情况有所不同,可据此作出早期经验性判断;但由于缺乏特异指标,早期鉴别致病菌种类需结合病情综合判断。

Objective To study the characteristics of neonatal sepsis caused by G＋ bacteria,G-bacteria and fungal.Methods Retrospectively analysis was performed on the clinical data of 226 neonates with sepsis hospitalized from Jan.2009 to Dec.2011.Results The detection rate of G＋ bacteria,G-bacteria and fungal was 50.9%,35.0%,and 14.1% respectively.G＋ and G-bacteria sepsis was more common in neonatal with longer gestational age and higher birth weight,while fungal sepsis was more common in premature and low birth weight infants and with more nosocomial infection.There were statistical differences in gestational age,birth weight and rate of nosocomial infection among the three groups（P0.05）.There were more neonatal with premature rupture of membranes（18 h） and amniotic fluid III degree polluter in G-group than those in G＋ group and fungal group（P0.05）.The percentage of early-onset sepsis in G-group was heigher than that in G＋ group and fungal group（P0.05）.The fever was less common and frequent apnea was more common in fungal group than those in G-group and G＋ groups（P0.05）.The WBC levels increased more markedly in G＋ group and G-group than that in fungal group（P0.05）.The hospitalization time of fungal group was longer than that of the G＋ group and G-group（P0.05）.There were no significant differences among the three groups in the cure rate and mortality rate（P0.05）.Conclusions The general situation,clinical manifestations and infection index are different in neonatal sepsis caused by different pathogens,which makes it possible for early empirical judgment.However,there is no specific indicators to distinguish neonatal sepsis caused by different pathogens.Early identification of the pathogen needs comprehensive judgment of the clinical conditions.Faster and sensitive methods need to be developed.