新生儿B族链球菌败血症33例临床分析

Clinical analysis of 33 cases of neonatal group B streptococcal sepsis

目的探讨新生儿B族链球菌（groupBstreptococcus，GBS）败血症的临床特点。方法收集2011年3月至2014年10月泉州市儿童医院NICU收治的GBS败血症患儿的资料，回顾性分析GBS败血症患儿的围产因素、临床表现、实验室检查、治疗与转归。结果GBS败血症33例，占住院患儿的2．0％。（33／16448）。其中早发型败血症21例，均为足月儿，呼吸窘迫13例、气促11例、青紫10例。晚发型败血症12例，足月儿8例，早产儿4例，以高热为首发症状人院10例，6例合并化脓性脑膜炎。33例血GBS阳性标本均对万古霉素敏感，青霉素联合美罗培南治疗有效，其中18例治愈出院，临床好转后自动出院9例，死亡2例，放弃治疗死亡4例，总病死率18．2％。结论新生儿GBS败血症临床症状明显，早发型病例以呼吸系统症状为主，晚发型病例以高热为首发症状。母孕后期应常规筛查，重视新生儿早期临床表现，尽早行病原学检测，合理足疗程使用敏感抗生素治疗。

Objective To explore the clinical characteristics of neonatal group B streptococcal sepsis （GBS） sepsis in order to provide the guide for early diagnosis and appropriate treatment. Methods A retro- spective review was performed and a total of 33 cases of neonatal GBS sepsis were identified in the NICU of Children＇s Hospital of Quanzhou from March 2011 to October 2014. The perinatal factors, clinical characteris- tics,laboratory finding, treatment and prognosis were analyzed. Results A total of 33 cases of neonatal GBS sepsis were identified. The incidence of neonatal GBS sepsis was 2. 0%o（ 33/16 448 ） among all the NICU pa- tients admitted at the same period. All 21 cases of early-onset GBS sepsis were term infants, which had 13 ca- ses of respiratory distress, 11 cases of anhelation and 10 cases of cyanosis as main initial clinical symptoms. Among 12 late-onset cases ,8 occurred in term infants, 10 with ardent fever as the main initial clinical symp- toms,6 combined with purulent meningitis. All the GBS strains were sensitive to vancomycin, then penicillin combined with meropenem therapy was effective. Of the 33 patients, 18 cured,9 discharged with improve- ment,2 died,4 patients died during hospitalization after being given up because of serious complication,total mortality was 18.2%. Conclusion The clinical manifestations of neonatal GBS sepsis are usually obviously and fatally, and with a high mortality. Antepartum prophylaxis, early diagnosis and timely sensitive antibiotics therapy are vital for reducing the incidence of complications and mortality of neonatal GBS sepsis.