小儿真菌性败血症的临床特征和危险因素分析  

Clinical features and risk factors of children with fungemia

作　　者：刘明月[1] 郭琳瑛[1] 张琪[1] 王菲[1] 黄偲元 刘霜[1] Liu Mingyue;Guo Linying;Zhang Qi;Wang Fei;Huang Siyuan;Liu Shuang.(Department of lntensive Care Unit, Affiliated Children＇s Hospital, Capital Institute of Pediatrics, Beijing 100020, China)

机构地区：[1]首都儿科研究所附属儿童医院ICU,北京100020

出　　处：《北京医学》2018年第2期124-126,131,共4页Beijing Medical Journal

摘　　要：目的探讨小儿真菌性败血症的临床特点及危险因素。方法回顾性分析2010-2016年,首都儿科研究所附属儿童医院收治的40例真菌性败血症患儿的临床资料,探讨其临床特点和易患危险因素。结果患儿年龄生后2 h至1岁8个月,中位数为38 d,其中新生儿16例(40%)。40例患儿中消化道畸形26例(65%)。临床表现有发热、呼吸暂停、呼吸困难、发绀、休克、腹胀、皮疹、鹅口疮等。根据是否存在消化道畸形,分为消化道畸形组和非消化道畸形组。消化道畸形组患儿发生休克、深静脉置管、静脉营养、接受消化道手术、气管插管、机械通气治疗、降钙素原(procalcitonin,PCT)>2 ng/ml、抗生素使用>2周和入住ICU>7 d的比例均高于非消化道畸形组,差异有统计学意义(P<0.05)。2组患儿在氟康唑治疗有效率及丙种球蛋白使用率上差异无统计学意义。结论新生儿和消化道畸形术后的患儿是真菌性败血症感染的高危人群,深静脉置管、静脉营养、气管插管、机械通气、抗生素使用>2周和入住ICU>7 d是真菌性败血症的危险因素,针对这些危险因素,应尽早实施预防并积极进行治疗。Objective To investigate the clinical features and risk factors of children with fungemia. Methods The retrospective study included 40 children admitted to the Affiliated Children＇ s Hospital of Capital Institute of Pediat- rics between 2010 and 2016. The clinical feature and risk factors were analyzed. Results The age of 40 cases ranged from 2 hours after birth to 20 months. The median age was 38 days old in which 16 cases were neonates （40%）. Twenty- six （65%） patients had digestive tract malformation. The 40 patients had clinical characteristics of fever, apnea, dyspnea, cyanosis, shock, abdominal distension, tetter, thrush. The children were divided into 2 groups according to the existence of digestive tract malformation （malformation group and non-malformation group）. Compared with the non-malformation group, the proportions of shock, central venous catheters, parenteral nutrition, gastrointestinal surgery, tracheal intubation, mechanical ventilation, procalcitonin （PCT） 〉 2 ng/ml, antibiotics 〉 2 weeks and ICU time 〉 7 days were statistically high- er in the malformation group （P 〈 0.05）. There was no statistical difference in fluconazol and gamma globulin treatment. Conclusion The disease prefers to attack the neonate and the child who has digestive tract malformation. The risk factors included central venous catheters, parenteral nutrition, tracheal intubation, mechanical ventilation, antibiotics 〉 2 weeks and ICU time 〉 7 days. Preventive measures should be taken in high-risk infants and early treatment is necessary in sus- pected patients.

关 键 词：儿童 真菌血症 危险因素 腹部手术 

分 类 号：R725.1[医药卫生—儿科]