新生儿败血症区分早发型和晚发型的临床意义

发布时间：2018-06-29 00:57

  本文选题：新生儿败血症 + 早发型　； 参考：《重庆医科大学》2015年硕士论文

【摘要】：目的：分析比较新生儿早发型败血症(early-onset neonatal septicemia, EOS)和新生儿晚发型败血症(late-onset neonatal septicemia, LOS)的临床特点、非特异性指标、病原菌分布及药敏情况,以指导临床诊断和治疗。方法：选取血培养阳性新生儿败血症患儿352例,根据发病时间将其分为早发型败血症和晚发型败血症,对其临床资料进行回顾性分析比较。结果：352例新生儿败血症中早发型144例(40.91%),晚发型208例(59.09%),且晚发型败血症中有108例(51.92%)为院内感染。早发型败血症多发生于足月儿[107/144例(74.31%)],晚发型败血症多发生于早产儿[77/208例(37.02%)]及低出生体质量儿[70/208例(33.65%),x2=4.123,P0.05]。早发型败血症新生儿窒息[21/144例(14.58%)]、宫内窘迫[14/144例(9.72%)]、羊水粪染[26/144例(18.06%)]、胎膜早破≥18h[31/144例(21.53%)]的比例高于晚发型[分别为17/208例(8.17%)、9/208例(4.33%)、13/208例(6.25%)、17/208例(8.17%),x2值分别为4.622、3.886、5.950、13.345,P均0.05。晚发型败血症出现体温异常[72/208例(34.62%)]、呕吐或腹胀[109/208例(39.42%)]、少吃少哭少动症状[79/208例(37.98%)]、脐炎或脓疱或皮肤破溃[33/208例(15.87%)]的比例大于早发型[分别为30/144例(20.83%)、35/144例(24.31%)、38/144例(26.39%)、11/144例(7.64%)x2值分别为7.853、66.116、5.153、5.265,P均0.05]。晚发型败血症高I/T值[27/184例(14.67%)]、CRP升高[76/206例(36.89%)]的比例明显高于早发型败血症[分别为9/133例(6.77%)、38/143例(26.57%)，，x2值分别为4.794、4.087,P均0.05]。晚发型败血症患儿更易发生细菌性脑膜炎[37/208例(17.79%)比12/144例(8.33%)；x2=6.348,P0.05)。早发型败血症致病菌以革兰阴性杆菌为主[占39.58%(57/144例),其中肺炎克雷伯菌肺炎亚种21例、大肠埃希菌20例],其次为凝固酶阴性葡萄球菌47例[占32.64%(47/144例)]；晚发型败血症致病菌以革兰阳性球菌为主[占58.65%(122/208例),其中凝固酶阴性葡萄球菌90例(43.27%)],其次为大肠埃希菌37例[17.79%(37/208例)。两组转归比较,差异无统计学意义(x2=1.187,P=0.552)。结论：早发型和晚发型败血症在临床、实验室检查方面存在一定差异。新生儿败血症区分早发型和晚发型对临床选用抗菌药物有一定参考价值。
[Abstract]:Objective: to analyze and compare the clinical characteristics, nonspecific indexes, pathogenic bacteria distribution and drug sensitivity of early-onset neonatal septicemia (EOS) and late-onset neonatal septicemiaemia (Los) in neonates, in order to guide clinical diagnosis and treatment. Methods: 352 cases of neonatal septicemia with positive blood culture were selected and divided into early septicemia and late septicemia according to the onset time. The clinical data were retrospectively analyzed and compared. Results among 352 newborns with septicemia, 144 (40.91%) had early onset, 208 (59.09%) had late onset and 108 (51.92%) had nosocomial infection. Early septicemia occurred in full-term infants [107 / 144 cases (74.31%)], late septicemia occurred in premature infants [77 / 208 cases (37.02%)] and low birth weight infants [70 / 208 cases (33.65%)]. The proportion of neonatal asphyxia with premature septicemia [21 / 144 (14.58%)], intrauterine distress [14 / 144 (9.72%)], feces staining of amniotic fluid [26 / 144 (18.06%)], premature rupture of membranes 鈮

本文编号：2080121