早产儿真菌血症42例临床分析

Clinical analysis of fungemia in 42 preterm infants

目的:探讨早产儿真菌感染的临床特征,提高早期识别与诊治。方法:对42例真菌血症早产儿的母孕史、出生史、临床表现特征、实验室检查和治疗转归等资料进行回顾性分析。结果:42例早产儿中,胎龄≤34周38例,出生体质量≤1 500 g25例。临床表现主要为频繁呼吸暂停16例,肤色发灰11例,喂养不耐受8例及不明原因的病情迅速恶化13例。发病因素为发病前使用抗生素>10 d 32例,静脉营养35例,应用外周中心静脉导管18例。实验室指标异常主要表现为血小板减少45.2%,C反应蛋白升高38.1%。结论:早产儿胎龄小、体质量低、使用抗生素、静脉营养及中心静脉导管均是早产儿真菌血症高危因素,且临床表现不典型,需要早期高度重视和及时诊治。

Objective：To explore the clinical features of preterm infants with fungal infection to improve the early diagnosis and treatment. Methods：The maternal pregnant history,neonatal birth history,clinical manifestation,labaratory examination and treatmnet outcome data of 42 preterm infants with fungemia were retrospectively analyzed. Results：Among 42 preterm infants,38 cases with equal to and less than 34 weeks gestational age and 25 cases with equal to and less than 1 500 g weight were found. The frequent apnea in 16 cases,grey skin in 11 cases,feeding intolerance in 8 cases and unexplained condition deteriorated rapidly in 13 cases were identified. The use antibiotics more than 10 days in 32 cases,intravenous nutrition in 35 cases and peripherally inserted central catheter in 18 cases were the morbidity factors. The laboratory test showed that thrombocytopenia decreased 45. 2%,and CRP increased 38. 1%. Conclusions：Little gestational age,low body mass,The antibiotics use,intravenous nutrition and peripherally inserted central catheter are the high risk factors in fungal infection of preterm infants. The clinical manifestations of fungal infection in preterm infants are atypical,which need to attach great importance to early diagnosis and timely treatment.