不同病原菌新生儿败血症临床特点研究

The clinical characteristics of neonatal sepsis caused by different pathogens

目的 探讨革兰阳性菌（G＋菌）、革兰阴性菌（G-菌）和真菌所致新生儿败血症的临床特点.方法 对2012年1月至2015年5月我院新生儿重症监护病房收治的新生儿败血症患儿资料进行回顾性分析,按病原不同,分为G＋菌组、G-菌组和真菌组.分析3组间一般资料、临床表现、实验室检查和治疗转归情况,应用方差分析、LSD法及x2检验或Fisher确切概率法比较组间差异.结果 共纳入202例新生儿败血症患儿.G＋菌组71例（35.2％）,G-菌组114例（56.4％）,真菌组17例（8.4％）.G＋菌组胎龄、出生体重大于G-菌组和真菌组[（36.0＆#177;3.8）周比（33.0＆#177;3.9）周、（31.2＆#177;3.2）周,（2 620＆#177;925）g比（1 999＆#177;849）g、（1 595＆#177;666）g,P＜0.05],医院感染所占比例低于G-菌组和真菌组（29.6％比70.2％、94.1％,P ＜0.05）,循环障碍、血糖异常、血小板计数下降发生率低于G-菌组和真菌组（P均＜0.05）,G＋菌组和真菌组差异无统计学意义（P＞0.05）.真菌组发病日龄大于G＋菌组和G-菌组[20.0（11.5,39.5）d比7.0（2.0,17.0）d、10.0（6.0,18.2）d,P＜0.05,深静脉置管比例高于G＋菌组和G-菌组（88.2％比25.4％、40.4％,P＜0.05）,治疗时间长于G＋菌组和G-菌组[22.0（12.0,37.5）d比14.0（10.0,17.0）d、14.0（11.0,18.0）d,P＜0.05],G＋菌组和G菌组差异无统计学意义（P＞0.05）.G-菌组呼吸暂停发生率高于G＋菌组和真菌组（P＜0.05）,G＋菌组和G＋菌组血白细胞计数明显升高或降低的比例及C反应蛋白升高的比例高于真菌组（P＜0.05）.结论 不同病原菌新生儿败血症的临床表现及实验室检查特点不同,可对早期经验性判断提供一定帮助.但因缺乏特异性指标,早期鉴别致病菌需结合病情综合判断.

Objective To study the characteristics of neonatal sepsis caused by gram positive （G ＋） bacteria,gram negative （G＋） bacteria and fungi.Method Clinical data of 202 neonates with sepsis hospitalized from Jan.2012 to May.2015 were studied.According to the different pathogens,202 neonates were divided into gram positive bacteria group,gram negative bacteria group and fungi group.The general information,clinical manifestation,laboratory examination and treatment outcome of the three groups were analysed with Chi square analysis,LSD,Fisher exact probability tests.Result A total of 202 cases of neonatal sepsis were recruited.The detection rate of gram positive bacteria,gram negative bacteria and fungi was 35.2% （71 cases）,56.4% （114 cases） and 8.4% （17 cases）,respectively.Comparing with gram negative group and fungi group,gram positive group had older gestational age （36.0 ± 3.8 w,compared with gram negative 33.0 ± 3.9 w,fungi group 31.2 ± 3.2 w,P 〈 0.05）,larger birth weight （2 620 ± 925 g compared with gram negative group 1 999 ± 849 g,fungi group 1 595 ± 666 g,P 〈 0.05）,lower nosocomial infection rate （29.6% compared with gram negative group 70.2%,fungi group 94.1%,P 〈0.05）,lower rate of shock,blood glucose disturbance and thrombocytopenia （P 〈 0.05）.There was no statistics difference between the gram negative group and fungi group.Comparing with the other two groups,fungi group was older [20.0 （11.5,39.5） d compared with gram positive group 7.0 （2.0,17.0） d,and gram negative 10.0 （6.0,18.2） d,P 〈 0.05].The rate of deep venous catheterization in fungi group was higher than that in gram positive group and gram negative group （88.2% compared with gram positive group 25.4%,gram negative group 40.4%,P 〈0.05）.The treatment course of fungi group was longer than that of the gram positive group and gram negative group [22.0 （12.0,37.5） d compared with the gram positive group 14.0 （10.0,17.0） d,gram negative group 14.0 （11.0,18.0） d,P 〈0.05].The incidence of apnea in the gram negative group was higher than that in gram positive group and fungi group （P 〈 0.05）.The rate of leukocytosis,leukocytopenia and elevated CRP were higher in gram negative and gram positive group （P 〈 0.05）.Conclusion The clinical manifestations and laboratory examinations in neonatal sepsis caused by different pathogens were different,which can help to early identification of different pathogenic infections.However,there is no specific indicators to differentiate neonatal sepsis caused by different pathogens.Early identification of the pathogen needs clinical acumen.