早产儿真菌性败血症临床分析(附16例报告)

Clinical analysis on the 16 cases of premature neonatal fungal septicemia

目的探讨早产儿真菌性败血症的临床特点,以提高该疾病的诊治水平。方法选择2013年1月—2014年9月湖北省妇幼保健院新生儿重症监护病房收治的早产儿真菌性败血症病例16例,对患者的一般状况、发病时间、首发症状、血小板、CRP、1,3-β-D葡聚糖、血培养结果感染指标进行回顾性分析,比较治疗前与治疗中、治疗后的血小板、C反应蛋白及1,3-β-D葡聚糖的变化情况。结果新生儿真菌性败血症的病原菌以热带假丝酵母菌为主,发病日龄为生后5～36 d,平均(14±5.5) d;喂养不耐受、频繁呼吸暂停、反应差、发热是新生儿真菌性败血症的常见首发症状;多数患儿出现血小板减少,C反应蛋白、1,3-β-D葡聚糖增高,抗真菌治疗7 d后多数患者血小板可恢复正常,治疗2～3周后C反应蛋白、1,3-β-D葡聚糖可恢复正常,应用氟康唑、卡泊芬净治疗新生儿假丝酵母菌性败血症可取得满意疗效。结论早产儿真菌性败血症的临床表现缺乏特异性,对有高危因素的早产儿血小板减少、1,3-β-D葡聚糖增高可考虑早期真菌感染,氟康唑仍为首要治疗新生儿真菌性败血症一线药物,早期发现及时治疗是治疗成功的关键。

Objective To study the clinical characteristics of premature neonatal fungal septicemia in order to improve diagnostic accuracy and treatment efficacy. Methods The general condition,time of onset,first presenting symptom,thrombocyte,C-reactive protein,1,3-β-D-glycan,blood culture results,infection indicators were analysed retros pectively in 16 cases of newborns with fungal sepsis who admitted to author's neonatal intensive care unit from January,2013 to September,2014;and changes of thrombocyte,C- reactive protein and 1,3-β-D-glycan were compared between before,during and after treatment. Results Candida tropicalis was the major pathogen of neonatal fungal sepsis;the onset time spanned 5-36 days after birth[an averaged of (14±5.5)days];the most common presenting symptoms were feeding intolerance,frequent apnea,poor response,and fever;thrombocytopenia and increased C- reactive protein level and 1,3-beta glucan D were seen in most patients,after 7 days of antifungal treatment,the platelets of the majority of the patients could rise to normal,CRP and 1,3-beta glucan D decrease to normal after 2 week of antifungal treatment. Admiistration of fluconazole and caspofungin could achieve satisfactory results for neonatal candida septicemia. Conclusion Premature neonatal fungal septicemia showed no specific clinical manifestations;but thrombocytopenia,increased 1,3-beta glucan D may be early considered fungal infections in the newborns with risk factors it should also be highly alerted to the possibility of fungal infection,Fluconazole is still primary and first-line drugs in the treatment of neonatal fungal,septicemia early detection and prompt treatment are the key elements to successful treatment.