新生儿早发型脓毒血症临床表现与治疗的中法对比

发布时间：2018-05-09 15:47

本文选题：新生儿 + 感染　；参考：《重庆医科大学》2012年硕士论文

【摘要】：目的：了解中法两国对早发型新生儿脓毒血症（early-onsetneonatal sepsis, EONS）在临床表现、诊断、治疗方面的不同，为提高我院对EONS的诊治水平提供依据。资料与方法：对法国斯特拉斯堡大学hautepierre医院妇女儿童中心和重庆医科大学附属儿童医院共146例EONS患儿的细菌谱、临床表现、抗菌药使用、产前危险因素记录和筛查情况进行回顾性分析。结果：我院常见致病菌为凝固酶阴性葡萄球菌（69.2%），大肠杆菌（15.4%），肺炎克雷伯菌（7.7%）和栖息微球菌（7.7%）；hautepierre医院为B族链球菌（33.3%），大肠杆菌（33.3%），凝固酶阴性葡萄球菌（16.7%）和莫拉氏菌（16.7%）。Hautepierre医院胃液和周围拭子培养常见大肠杆菌（33.3%），B族链球菌（21.2%），凝固酶阴性葡萄球菌（18.2%）等。我院抗菌药使用总天数（11.4±7.2d）、平均每个患儿抗菌药使用的种类（3.1±0.9）和换抗菌药人数比例（70.2%）均大于hautepierre医院（6.2±2.5d，2.2±0.8，9.9%）。两院首剂抗菌药常用二联组合（我院二代头孢+半合成青霉素，hautepierre医院阿莫西林+阿米卡星）。我院二、三线抗菌药常见碳青霉烯类和万古霉素，hautepierre医院常见三代头孢和万古霉素。我院对多种产前危险因素（绒毛膜羊膜炎、母亲发热、破膜到胎儿娩出时间、孕期是否行阴道拭子或尿路感染情况、羊水污染、产前抗菌药使用、EONS的既往史）的记录率均低于hautepierre医院；羊水污染、破膜时间是否延长和宫内窘迫情况筛查阳性率两院有差异。在生后立即出现异常而入院的患儿中，两院最常见的异常均为呼吸困难（96.5%vs.88.2%）；在生后一段时间出现异常的患儿中，两院常见入院原因构成比不同：我院常见原因为呼吸困难（44.4%），反应差（22.2%）等；hautepierre医院常见原因为C反应蛋白升高（78.2%），发热（5.5%）等。两所医院CRP诊断早发型新生儿脓毒血症的假阴性率无统计学差异。结论：重视产前危险因素的筛查与记录、促进与产科的合作可提高我院对EONS患儿的早期诊断的准确性，积极寻找病原菌和药敏试验可能减少换药次数和抗菌药使用时间。我国仍需大样本、多中心的研究来确定划分早发和晚发型新生儿脓毒血症的必要性和具体分界点，并完善脓毒血症经验抗菌药使用的临床指南，也需要更多的关于我国与欧洲国家在EONS诊治方面的对比性研究。
[Abstract]:Objective: to investigate the differences of clinical manifestations, diagnosis and treatment between China and France in the treatment of early onset neonatal sepsis (EONSs), and to provide a basis for improving the level of diagnosis and treatment of EONS in our hospital. Materials and methods: the bacterial spectrum, clinical manifestations and antimicrobial use of 146 children with EONS were collected from the Women's and Children's Center of hautepierre Hospital, University of Strasbourg, France and the affiliated Children's Hospital of Chongqing Medical University. Antepartum risk factors were recorded and screened for retrospective analysis. Results: the common pathogenic bacteria in our hospital were coagulase negative staphylococci 69.2, Escherichia coli 15.4 and Klebsiella pneumoniae 7.7. and Micrococcus pernica 7.7. hautepierre Hospital: group B streptococcus 33. 3%, Escherichia coli 33. 33%, coagulase negative Staphylococcus 16. 775) and Mora's fungus 16. 777. Hautepierre Common Escherichia coli was cultured in gastric juice and peripheral swabs in hospital. The bacteria of Streptococcus sp. B was 21.2and coagulase negative staphylococcus was 18.2and so on. The total number of days of use of antibiotics in our hospital was 11.4 卤7.2 days, the average number of antibiotics used per child was 3.1 卤0.9) and the ratio of the number of patients who changed antibiotics was 70.2), which was higher than that in hautepierre hospital (6.2 卤2.5 days, 2.2 卤0.8, 9.9g). Amoxicillin Amikacin, second generation cephalosporin semi-synthetic penicillin, amoxicillin Amikacin, Amoxicillin Amikacin Hospital, our hospital. Common carbapenems and vancomycin in the second and third-line antimicrobial agents of our hospital are common in the third generation of cephalosporins and vancomycin. The risk factors (chorioamnionitis, febrile mother, time between rupture and delivery of fetus, vaginal swab or urinary tract infection during pregnancy, amniotic fluid contamination) were analyzed in our hospital. The record rate of antepartum antibiotics use EONS was lower than that of hautepierre hospital, amniotic fluid pollution, membrane breaking time prolongation and positive rate of intrauterine distress screening were different. The most common abnormalities in both houses of children who were admitted to the hospital immediately after birth were dyspnea 96.5a and vs.88.2e.In those who had been abnormal for some time after birth, the most common abnormalities in both houses were dyspnea. The common causes of hospitalization in both houses were different: the common causes in our hospital were dyspnea (44.4am), poor response (22.2) and so on. The common causes were C-reactive protein elevation (78.2%), fever (5.5%) and so on. There was no significant difference in false negative rate of CRP in early onset neonatal sepsis between the two hospitals. Conclusion: attention should be paid to the screening and recording of prenatal risk factors and cooperation with obstetrics can improve the accuracy of early diagnosis of EONS children in our hospital. Actively searching for pathogenic bacteria and drug sensitivity tests may reduce the times of changing drugs and the time of using antimicrobial drugs. China still needs a large sample and multi-center study to determine the necessity and specific demarcation points for distinguishing early and late onset neonatal sepsis, and to perfect the clinical guidelines for the use of antibiotics in sepsis experience. There is also a need for more comparative research on EONS diagnosis and treatment between China and European countries.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R722.13

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