新生儿严重感染与全身炎症反应综合征关系探讨

Preliminary study on the relationship between the systemic inflammatory response syndrome and severe neonatal infection

为探讨全身性炎症反应综合征(SIRS)和新生儿重症感染的关系,对1995年1月至2000年12月收入ICU诊断为新生儿败血症的48例患儿进行分析,其中男32例,女16例;平均孕周36周(27周～42周);平均出生体重1.85kg(1.1kg～3.5kg);平均入院日龄7.8天(2小时～28天)。按照第二届世界儿科ICU大会和Hayden提出的SIRS诊断标准和分级进行分组,结果显示,95.8％符合SIRS诊断标准(46/48例),符合脓毒症7例,严重脓毒症16例,脓毒性休克23例。随着SIRS病情的进展,病死率增高,脓毒症组无死亡,余2组死亡率分别为31.2％和78.3％(P<0.01);随SIRS病情加重,MODS病例增多,脓毒症组无发生,余2组分别为37.5％和95.7％(P <0.01)。提示SIRS诊断标准亦适用于新生儿严重感染,该分组可以区别疾病严重程度和预测预后。

To explore the relationship between systemic inflammatory response syndrome(SIRS) and severe neonatal systemic infection 48 newborn infants with septicemia admitted to NICU were enrolled from Jan. 1995 to Dec. 2000. Of them 32 cases were boys and 16 girls with the average body weight 1.85kg(l. 1~3.5kg).The mean gestational age was 36(range from 17 to 42) weeks The mean admitted age was 7~8 days(2 h^28 days). According to the SIRS diagnostic criteria of the second International Pedatric ICU Conference and the classification system proposed by Hayden, 95.8% (46/48) newborn infants met the diagnostic criteria of SIRS including 7 neonates with pyosepticemia, 16 neonates with severe type of pyosepticemia, 23 with pyoseptic shock, with the severity of SIRS aggravated. The mortality and the number of patients with MODS could be increasingly elevated following the aggravation of the disease severity. No patients had MODS and died in pyosepticemia group, while as it was true in other two groups.The mortality was 31.2% vs 78.3% (P<0.01) and the patient number of MODS was 37. 5% vs 95. 7%(P<0. 01) between latter two groups respectively, indicating that the diagnostic criteria for SIRS and the classification system of SIRS could also be adopted to the neonates with severe infection and used to identify the severity of the disease and also predict the outcome.