新生儿重症监护病房中新生儿真菌败血症的临床特点

发布时间：2018-05-17 15:48

本文选题：脓毒症 + 菌血症　；参考：《北京大学学报(医学版)》2017年05期

【摘要】：目的:探讨新生儿真菌败血症的临床特点,并与新生儿细菌败血症的临床特点进行比较,提高对新生儿真菌败血症的认识。方法:选取2011—2016年北京大学第一医院新生儿重症监护病房中收治的新生儿真菌败血症患儿的临床资料进行回顾性分析,同时选取同期住院的新生儿细菌败血症患儿,对两组患儿的临床特点进行比较。结果:共纳入新生儿真菌败血症患儿15例,真菌败血症发生情况为0.52%,极低出生体重儿为2.5%。临床表现非特异,所有患儿应用肠外营养、广谱抗生素,13例患儿留置外周放置中心静脉导管(peripheral inserted central venous catheter,PICC)。病原学分析显示,光滑假丝酵母菌(Candida glabrata)占第一位,对二性霉素B均敏感,一株光滑假丝酵母菌对氟康唑耐药。与同期34例新生儿细菌败血症患儿比较,真菌败血症组的血小板计数明显低于细菌败血症组(61×109/L vs.178×109/L,P=0.004),血小板下降比例明显高于细菌败血症组(80.0%vs.29.4%,P=0.001),留置PICC比例高于细菌败血症组(86.7%vs.55.7%,P=0.037)。受试者工作特征曲线(receiver operating characteristic curve,ROC曲线)分析发现,以血小板计数145×109/L为界值时,预测新生儿真菌败血症的敏感度和特异度分别为61.8%和92.9%。经规范的抗真菌治疗后,真菌败血症患儿均治愈,血小板恢复正常,肝、肾功能未见明显变化。结论:新生儿真菌败血症的临床表现呈非特异性,病原以光滑假丝酵母菌占第一位,给予规范治疗疗效较好,血小板降低和留置PICC可能提示真菌感染。
[Abstract]:Objective: to explore the clinical characteristics of neonatal fungal septicemia and compare it with neonatal bacterial septicemia to improve the understanding of neonatal fungal septicemia. Methods: the clinical data of neonates with fungal septicemia admitted in the neonatal intensive care unit of the first Hospital of Peking University from 2011 to 2016 were retrospectively analyzed. The clinical characteristics of the two groups were compared. Results: a total of 15 neonates with fungal septicemia were included. The incidence of fungal septicemia was 0.52and that of very low birth weight infants was 2.5. The clinical manifestations were nonspecific. All the children were treated with parenteral nutrition. Thirteen patients with broad-spectrum antibiotics were placed in peripheral venous catheterization with central inserted central venous catheterization. The pathogen analysis showed that Candida glabrata was the most sensitive to diamicin B, and a Candida glabrata was resistant to fluconazole. Compared with 34 neonates with bacterial septicemia in the same period, the platelet count in fungal septicemia group was significantly lower than that in bacterial septicemia group (61 脳 10 ~ 9 / L vs.178 脳 10 ~ (9 / L) P ~ (0.004), and the percentage of platelet decline was significantly higher than that in bacterial septicemia group (n = 80.0vs.29.4P ~ + 0.001). The percentage of indwelling PICC was higher than that in bacterial septicemia group (86.7vs.55.7V). The sensitivity and specificity of predicting neonatal fungal septicemia were 61.8% and 92.9%, respectively, when the platelet count was taken as the threshold value of 145 脳 10 ~ 9 / L, the receiver operating characteristic curved-ROC curve showed that the sensitivity and specificity of predicting neonatal fungal septicemia were 61.8% and 92.9%, respectively. After standard antifungal therapy, all the children with mycosepticemia were cured, platelets returned to normal, and liver and kidney function did not change obviously. Conclusion: the clinical manifestations of neonatal fungal septicemia are nonspecific, the first pathogen is Candida lucidum, and the standard treatment is better. The decrease of platelet and the indwelling of PICC may suggest fungal infection.
【作者单位】：北京大学第一医院儿科;
【分类号】：R722.131

【相似文献】