356例新生儿血小板减少症的临床分析

发布时间：2018-04-15 10:38

本文选题：血小板减少症 + 新生儿　；参考：《吉林大学》2012年硕士论文

【摘要】：新生儿血小板减少症（Neonatal thrombocytopenia，NTP）是儿科常见而严重的疾病之一，在危重新生儿中的发病率高达20%~40%~[1]。近年来国内外专家研究认为，外周血血小板计数的高低可作为NTP的危重症评分指标~[2-3]，而NTP的预后与患儿病因及血小板的高低密切相关~[2，4-5]。由于患有新生儿血小板减少症者其发病原因不同，各具有其临床特点，本文旨在通过比较其在发病因素、临床特征和预后的不同，以其更好地为本病的诊断、预防及治疗提供一定的参考依据。本文筛选于2011年1月一2011年12月吉林大学第一医院新生儿科收治的3108例病例，其中选择病例资料完整，血小板小于100×10~9/L者，发病日龄为28天内符合纳入标准者的新生儿血小板减少症病例，共356例，对满足以上标准的患儿按胎龄进行分组，分为早产儿组208例（早期早产儿组123例，晚期早产儿组80例），足月儿组153例。分别比较组间新生儿血小板减少症发生有关的因素、临床特点及预后情况，主要包括:1、发病因素：①母亲因素：胎盘及羊水异常等；②患儿因素：窒息、梅毒、肺炎、败血症、新生儿呼吸窘迫综合征等。2、临床特点：血小板数目、新生儿血小板减少症发生时间。结果显示：本研究中新生儿血小板减少症构成比为11.5%（356/3108），其中早产儿占57%，足月儿占43%。死亡率为17.1%。其中血小板数目占38.7%，血小板减少症发生时间≤7天占58.1%。其中母亲合并妊娠相关性血小板减少占2.5%（9/356），胎盘异常占10.7%（38/356），羊水异常占25.5%（91/356）。新生儿血小板减少症的常见原因分别是：败血症36%（128/356）、新生儿呼吸窘迫综合征34.8%（124/356）、窒息21.9%（78/356）、先天性巨细胞病毒感染18.3%（65/356）、真菌感染10.4%(37/356)、动静脉换血术5%（18/356）、梅毒2.8%（10/356）。将上述因素行组间比较，有统计学意义的是NTP发生时间≤7天、羊水异常、换血、败血症、真菌感染及CMV感染。得出结论： 1、本研究中新生儿血小板减少症构成比为11.5%，早产儿发病率高于足月儿，，在败血症致血小板减少症中早产儿比足月儿更为常见。 2、本研究中新生儿血小板减少症的常见原因依次是：败血症、新生儿呼吸窘迫综合征、窒息、先天性巨细胞病毒感染、真菌感染、动静脉换血术、梅毒。 3、早期早产儿组与足月儿组相比，真菌感染致新生儿血小板减少症中早期早产儿更为常见；而羊水异常、动静脉换血术致血小板减少症中足月儿更为常见。 4、早期早产儿发生血小板减少症多为生后1周以上，而晚期早产儿、足月儿发生血小板减少症多为1周以内。
[Abstract]:Neonatal thrombocytopenia (NTP) is one of the common and serious diseases in pediatrics.In recent years, experts at home and abroad have found that the level of platelet count in peripheral blood can be regarded as the critical score of NTP, and the prognosis of NTP is closely related to the etiology and platelet level of children.Because the patients with neonate thrombocytopenia have different causes and have their own clinical characteristics, the purpose of this article is to make a better diagnosis of the disease by comparing the factors, clinical characteristics and prognosis of the disease.Prevention and treatment provide some reference basis.From January 2011 to December 2011, 3108 cases of neonatal pediatrics admitted in the first Hospital of Jilin University were selected. The data of the selected cases were complete and the platelets were less than 100 脳 10 ~ (9 / L).A total of 356 cases of neonatal thrombocytopenia, which met the criteria within 28 days, were divided into two groups according to gestational age: 208 cases of premature infants (123 cases of early preterm infants).There were 80 cases of advanced premature infants and 153 cases of term infants.The related factors, clinical characteristics and prognosis of neonatal thrombocytopenia were compared among the two groups, mainly including 1: 1, 1 maternal factor: placental and amniotic fluid abnormality and other factors: asphyxia, syphilis, pneumonia, septicemia, etc.Neonatal respiratory distress syndrome, etc., clinical characteristics: platelet count, time of occurrence of neonate thrombocytopenia.The results showed that the constituent ratio of neonate thrombocytopenia in this study was 11.5 / 356 / 3108g, of which 57 were premature and 43 were full-term.The mortality rate was 17.1%.Platelet count was 38.7 and thrombocytopenia occurred in less than 7 days (58.1%).Among them, maternal thrombocytopenia associated with pregnancy accounted for 2.5%, placental abnormalities accounted for 10.7%, amniotic fluid abnormalities accounted for 95% of 356U, and amniotic fluid abnormalities accounted for 10.7%.The common causes of neonatal thrombocytopenia are as follows: septicemia 36 / 128 / 356, neonatal respiratory distress syndrome 34.8 / 356, asphyxia 21.9 / 78 / 356, congenital cytomegalovirus infection 18.3 / 356m, fungal infection 10.4 / 37 / 356, arteriovenous exchange 518 / 356m, syphilis 2.80.10 / 356.The above factors were compared between the groups, the time of occurrence of NTP was less than 7 days, amniotic fluid abnormality, exchange of blood, septicemia, fungal infection and CMV infection.It is concluded that:1. The proportion of neonatal thrombocytopenia in this study was 11.5, the incidence of premature infants was higher than that of term infants, and premature infants were more common in septicaemic thrombocytopenia than full-term infants.2. The common causes of neonatal thrombocytopenia in this study were septicemia, neonatal respiratory distress syndrome, asphyxia, congenital cytomegalovirus infection, fungal infection, arteriovenous exchange, syphilis.3. Compared with term infants, early premature infants were more common in early premature infants than those in term infants, while amniotic fluid abnormalities and thrombocytopenia due to arteriovenous exchange were more common in term infants.4Thrombocytopenia occurred in early preterm infants more than one week after birth, but in advanced preterm infants, thrombocytopenia occurred within 1 week.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R722.19

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