新生儿B族链球菌败血症的临床研究  

Retrospective study of group B hemolytic streptococci sepsis in newborn

作　　者：沈艳华[1] 刘红[1] 齐宇洁[1] 董世霄[1] 靳绯[1] 翁景文[1] 吴海兰[1] 

机构地区：[1]北京儿童医院新生儿中心NICU,北京100045

出　　处：《山西医科大学学报》2016年第11期1041-1045,共5页Journal of Shanxi Medical University

摘　　要：目的探讨新生儿B族链球菌（GBS）败血症的临床特点及诊治。方法回顾性分析2008-01～2014-01于我院新生儿重症监护病房收治、血培养阳性的21例GBS败血症新生儿,记录母亲孕产史,患儿围产期情况、临床表现、实验室检查、治疗经过及预后等,结合相关文献对新生儿GBS败血症临床特点进行探讨。结果共收治21例新生儿GBS败血症患儿,男15例,女6例;早产儿2例;〈7 d发病7例,其中合并化脓性脑膜炎4例,≥7 d发病14例,其中合并化脓性脑膜炎10例。临床表现：21例均反应差,发热14例,呼吸异常10例,休克7例,惊厥5例。实验室检查：血WBC升高（〉19.5×10^9/L）8例,降低（〈5×10^9/L）13例;CPR升高21例。血培养无乳链球菌21例,脑脊液培养无乳链球菌6例。治疗：青霉素加头孢曲松11例,美平加青霉素8例,头孢曲松加万古霉素2例。转归：治愈12例,好转7例,放弃治疗后死亡2例。结论新生儿GBS败血症病情凶险,致残率高,病死率高。对于有高危因素的新生儿及孕母,应作为重点监测对象,做到早发现、早治疗。Objective To explore the diagnosis and treatment of group B hemolytic streptococci（ GBS） sepsis in the newborn. Methods Totally 21 cases of GBS sepsis in the newborn admitted to Neonatal Intensive Care Unit of Beijing Children＇s Hospital from January 2008 to January 2014 were enrolled in this study. The diagnosis of GBS sepsis was confirmed by blood culture. Clinical data were collected retrospectively including maternal history,perinatal events,clinical features,laboratory findings,treatment and prognosis. Literatures on GBS infection were reviewed. Results Among 21 cases,15 male and 6 female,2 were preterm. There were 7 early onset cases（ 〈7 d）,including 4 cases complicated with purulent meningitis,and 14 cases of late onset（ ≥7 d）,including 10 cases accompanied with purulent meningitis. All the 21 cases had poor response,and there were 14 cases of fever,10 cases of respiratory symptoms,7 cases of shock and 5 cases of convulsion. White blood cell count increased in 8 cases（ 〉19. 5 × 10^9/ L） and decreased in 11 cases（ 〈5 × 10^9/ L）. CRP was elevated in all of 21 cases,and blood culture was all positive. Six cases also had positive cerebrospinal fluid findings. Eleven cases were treated with penicillin combined with ceftriaxone,8 cases were given meropenem combined with penicillin,and 2 cases were treated with ceftriaxone combined with vancomycin. Among 21 cases,12 cases were cured,7 cases exhibited improved clinical symptoms,and 2 infants died after withdraw. Conclusion Neonatal GBS sepsis is a serious clinical condition with high morbidity and mortality rates. Neonates and pregnant women with high risk should be monitored carefully in order to diagnose and give appropriate treatment promptly.

关 键 词：B族链球菌 败血症 新生儿 

分 类 号：R631.3[医药卫生—外科学]