不同类型新生儿败血症的临床分析

Clinical analysis of different types of neonatal sepsis

目的研究不同类型新生儿败血症的临床特点,指导临床治疗。方法选择确诊为新生儿败血症的121例患儿,根据发病时间将其分为早发型败血症(生后72 h内)和晚发型败血症(出生72 h后)。分析比较早发型和晚发型败血症患儿的临床特点。结果 121例新生儿败血症中,早发型35例(28.9%),晚发型86例(71.1%)。早发型败血症多发生于足月儿(51.4%),晚发型败血症多发生于早产儿(88.4%)和低出生体质量儿(87.2%),两者比较差异具统计学意义(P<0.05)。晚发型败血症患儿发生腹胀或喂养不耐受(72.1%)、反应欠佳(57.0%)及合并化脓性脑膜炎(37.2%)比例大于早发型(相应为34.3%、31.4%、17.1%),两者比较差异具统计学意义(P<0.05)。早发型败血症患儿血小板计数减低比例(62.9%)较晚发型(29.1%)高(P<0.05),两者比较差异具统计学意义(P<0.05)。早发型败血症的主要致病菌是大肠埃希菌和肺炎克雷伯菌,晚发型败血症的主要致病菌是凝固酶阴性葡萄球菌。结论早发型败血症多发生于足月儿,晚发型败血症多发生于早产儿和低出生体质量儿,两种败血症的临床表现存在一定的差异,应结合不同类型的特点进行治疗。

Objective To explore the clinical characteristics of different types of neonatal sepsis and provide the advising to clinic. Methods One hundred and twenty-one neonates with sepsis were divided into two groups：early-onset sepsis （occurring within 72 h of birth）and late-onset sepsis （occurring at more than 72 h after birth）. The clinical characteristics of early-onset and late-onset sepsis were analyzed and compared between different types of sepsis. Results Thirty-five cases （28.9%）were early-onset sepsis and 86 cases （71.1%）were late-onset sepsis. Most neonates with early-onset sepsis were term infants,while low birth weight and preterm infants accounted for the majority of cases of late-onset sepsis （P〈0.05 ）.The incidences of abdominal distension or feeding intolerance （72.1%）,poor activity （57.0%）,meningitis （37.2%）in late-onset sepsis were higher than those （34.3%,31.4,1 7.1%）in late-onset （P〈0.05 ）,Thrombocyto-penia in early-onset group sepsis （62.9%）was more common than that （29.1%）in late-onset group （P〈0.05）. The major pathogens in early-onset group were Escherichia coli,followed by Klebsiella pneumoniae, while late-onset sepsis was major caused by Coagulase negative staphylococcus. Conclusion Early-onset sepsis mainly occurs in term infants,and late-onset sepsis mainly occurs in premature and low birth weight infant.There are a number of different clinical features between them.