13例早产儿真菌性败血症的临床研究  

13 cases of fungal sepsis in premature infants

作　　者：陈历耋[1] 王淑莲[1] 廖奇[1] 邓永红[1] 王燎原[1] Chen Lidie;Wang Shulian;Liao Qi;Deng Yonghong;Wang Liaoyuan(Department of Neonatology,Loudi Central Hospital,Loudi 417000,China)

机构地区：[1]娄底市中心医院新生儿科,417000

出　　处：《国际医药卫生导报》2019年第15期2507-2509,共3页International Medicine and Health Guidance News

摘　　要：目的研究新生儿重症监护室(NICU)早产儿真菌性败血症的临床特点、病原分布、药物敏感试验及治疗效果,为其预防及早期诊治提供依据。方法选取2013年1月至2018年1月本院新生儿科确诊真菌性败血症的早产儿13例,分析其危险因素、临床特点、病因菌及药物敏感试验。结果13例真菌性败血症早产儿,胎龄26~35周,出生体质量700~2650g,其中13例经验性应用广谱抗生素及全肠外静脉营养,7例机械通气,11例深静脉置管(PICC、CVC);临床主要表现为频繁呼吸暂停、反应差、胃潴留、腹胀、低体温、发热、灌注差等症状;检验全血白细胞<4×10^9 3例,血小板<100×10^12 3例,CRP升高10例;11例早产儿真菌G试验(血浆1,3-β-D葡聚糖)均明显升高,达113.3~677.1pg/ml,全部患儿均为念珠菌属感染,11例白色念珠菌,2例近平滑假丝酵母菌;药物敏感试验对氟康唑(大扶康)敏感率92.3%(12/13),伏立康唑100.0%(13/13),两性霉素敏感率100.0%(13/13);12例治愈出院,1例放弃治疗。结论 早产儿真菌性败血症以念珠菌属感染为主;缺乏特异性表现,可伴白细胞、血小板降低,CRP增高,真菌G试验明显升高,预防及早期积极治疗效果较好。Objective To study the clinical characteristics, pathogen distribution, drug sensitivity test, and therapeutic effect of fungal sepsis in preterm infants in neonatal intensive care unit (NICU), and provide some evidences for its prevention, early diagnosis, and treatment. Methods A total of 13 premature infants diagnosed with fungal sepsis in our department from January, 2013 to January, 2018 were enrolled. The risk factors, clinical features, etiology, and drug sensitivity test were analyzed. Results 13 cases of premature infants with fungal sepsis’ gestational age was 26-35 weeks, and their birth weight 700-2 650 g. All the 13 cases empirically took broad-spectrum antibiotics and total parenteral venous nutrition;7 cases took mechanical ventilation;and 11 cases took deep venous catheter (PICC, CVC). The clinical manifestations included frequent apnea, poor response, gastric retention, abdominal distension, hypothermia, fever, poor perfusion, and other symptoms. The whole blood leukocytes was < 4×109 in 3 cases, and platelets < 100×1012 in 3cases;CRP increased 10 cases;fungal G test (plasma 1,3-β-D glucan) were significantly increased in 11 cases, reaching 113.3 to 677.1 pg/ml);all the cases got Candida infection, including 11 cases of Candida albicans and 2 cases of Candida parapsilosis. The sensitivity of drug sensitivity test to fluconazole (Da Fukang) was 92.3%(12/13), and that to voriconazole 100.0%(13/13), and that to amphotericin 100.0%(13/13). 12 cases were cured and discharged, and 1 case gave up the treatment. Conclusion Fungal sepsis in premature infants is mainly caused by Candida infection;it is lack of specific manifestations, and associates with decreased white blood cells and platelets, increased CRP, and increased fungal G test;better prevention and early active treatment is effective.

关 键 词：早产儿 真菌感染 败血症 

分 类 号：R722.6[医药卫生—儿科]