新生儿坏死性小肠结肠炎并发败血症临床分析

发布时间：2018-01-30 08:02

  本文关键词： 新生儿 坏死性小肠结肠炎 败血症 病原菌　出处：《重庆医科大学学报》2013年10期 　论文类型：期刊论文

【摘要】：目的:了解新生儿坏死性小肠结肠炎(neonatal necrotizing enterocolitis,NEC)并发败血症的发病率、相关高危因素及病原菌。方法:对2000年7月至2013年2月在我院确诊的277例新生儿NEC患儿的临床资料进行回顾性统计,对并发败血症群体和其血/腹腔液培养结果进行分析总结。结果:我院新生儿NEC并发败血症的发病率为28.5%(79/277)。79例患儿中,平均胎龄(36.62±3.26)周,早产儿32例(40.5%),早产儿的发生率更高(P=0.049);平均出生体质量(2 551.06±737.90)g;平均发病日龄(10.30±12.18)d,早产儿平均发病日龄(12.90±16.23)d,胎龄越小,发病时间越晚;母亲围产期因素以感染性疾病史、胎膜早破及羊水异常居多;临床表现以腹胀、呕吐、少吃少哭少动和高胆红素血症为主;其他主要合并或并发症为肺炎、肠穿孔和腹膜炎;血液分析符合临床诊断标准72例(91.1%);治愈19例(24.1%),好转28例(35.4%),放弃23例(29.1%),死亡9例(11.4%)。临床分期以Ⅲ期为主(49例,62.2%)。培养结果:72份标本共分离病原菌13种38株,血培养阳性率46.9%,腹腔液培养阳性率66.7%,主要有肺炎克雷伯菌(29.1%)和大肠埃希菌(29.1%)。结论:Ⅱ期以上NEC易并发败血症,病原菌以肠杆菌科为主。确诊NEC时,应常规做血培养,重视厌氧菌培养,并定期监测实验室指标,注意监控疾病发展,以便能切断或减少肠源性败血症发生的机会。
[Abstract]:Objective: to investigate the incidence of septicemia in neonatal necrotizing enterocolitis (necrotizing). Methods: the clinical data of 277 neonates with NEC diagnosed in our hospital from July 2000 to February 2013 were analyzed retrospectively. Results: the incidence of neonatal NEC complicated with septicemia in our hospital was 28.579% 2770.79 cases. The average gestational age was 36.62 卤3.26 weeks, 32 cases of premature infants were 40.5% and the incidence of preterm infants was higher than 0.049% of preterm infants. The average birth weight was 255.1.06 卤737.90 g; The average onset age was 10.30 卤12.18 days, and the average onset age of premature infants was 12.90 卤16.23 days. The smaller the gestational age, the later the onset time. The maternal perinatal factors included infectious diseases, premature rupture of membranes and amniotic fluid abnormalities. The main clinical manifestations were abdominal distension, vomiting, less eating, less crying, less movement and hyperbilirubinemia. Other major complications or complications were pneumonia, intestinal perforation and peritonitis; The blood analysis was in accordance with the clinical diagnostic criteria in 72 cases. 19 cases were cured, 28 cases improved 35. 4%, 23 cases abandoned 29. 1%, 9 cases died 11. 4%. The clinical stage was mainly stage 鈪，

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