新生儿感染性休克53例临床分析  

Clinical characteristics of 53 cases with neonatal septic shock

作　　者：张国琴[1] 戎群芳[1] 龚小慧[1] 滕国良[1] 张育才[1] 张宇鸣[1] 

机构地区：[1]上海交通大学附属儿童医院急救中心,上海200040

出　　处：《临床儿科杂志》2007年第11期898-901,共4页Journal of Clinical Pediatrics

摘　　要：目的提高对新生儿感染性休克的认识,以提高抢救的成功率、改善预后。方法总结2000年1月～2005年12月NICU收住的53例感染性休克患儿的临床资料,分析其临床表现、引起死亡的高危因素及治疗方案的有效性。结果6年间NICU共收治患儿1454例,新生儿败血症155例,其中感染性休克发生率为33.5%(53/155例)。53例中男31例,女22例;平均胎龄(37.28±3.70)周;平均出生体重(2670±945)g;死亡25例,病死率为47.2%。临床早期表现均有反应差、意识改变、肢体末梢凉、毛细血管充盈时间≥3s;约75%患儿有呼吸增快或节律改变、心率增快或减慢、尿量减少或无尿,仅25%患儿有低血压。血培养阳性率为45.3%。容量复苏首剂液量均按20ml/kg,在1h内输注,其中9例进行了2次扩容,2例扩容3次。死亡高危因素有:腹胀、需机械通气、多脏器功能衰竭、碳酸氢钠(SB)加低分子右旋糖酐扩容等。结论新生儿感染性休克病死率较高,休克往往发生在血压降低之前。需机械通气、腹胀、早期用SB加低分子右旋糖酐、多脏器功能衰竭者预后差。累及脏器越多,病死率越高。Objectives To better know neonatal septic shock and to improve survival rate and life quality of neonates with septic shock, a 6-year （from Jan. 2000 to Dec. 2005） retrospective study of 53 neonates with septic shock was conducted. Methods Data of 53 cases with neonatal septic shock in our neonatal intensive care unit （NICU） were analyzed. Clinical characters, therapeutic approach and mortality related high risk factors were reviewed. Results During this period, a total 1454 patients were admitted in our NICU, of them, 155 cases were sepsis and 53 were septic shock. Incidence of septic shock was 33.5% （53/155）. Among patients with septic shock, 31 were male and 22 were female. Average gestational age was （37.28 ± 3.70） weeks and birth weight was （2 670 ± 945） g. In septic shock group, 25 cases were dead and the mortality was 47.2%. Early clinical characters of this group were bad response, change of consciousness, cool extremities, prolonged capillary filling time （ ≥ 3 sec）, change of respiration rate and heart rate, less or no urine; however, incidence of hypotension was only 26.4%. In all of the patients with shock, the first fluid dosage of volume resuscitation was 20 ml/kg within 1 hr, with the exception of 9 cases being given two dosage and 2 cases given three dosages. The rate of pathogen positive in blood cultures was 45.3%. Abdominal distention, mechanical ventilation, multiple organ dysfunction, volume resuscitation with sodium bicarbonate and dextran in first 2 hrs were high risk factors related to mortality. Conclusions Septic shock is one of the leading causes of neonatal mortality. Shock often appears before hypotension. Abdominal distention, mechanical ventilation, multiple organ dysfunction, fluid volume resuscitation with SB and dextran were high risk factors of mortality in septic shock.

关 键 词：新生儿 败血症 感染性休克 临床特征 

分 类 号：R722.1[医药卫生—儿科]