82例新生儿败血症病原学与临床特点  

Etiological and clinical characteristics of 82 cases of neonatal sepsis

作　　者：张敏[1] 杨帆[1] 程玲[1] 罗智花[1] 王琍琍[1] ZHANG Min;YANG Fan;CHENG Ling;LUO Zhi-hua;WANG Li-li(The First Affiliated Hospital of Anhui Medical University,Hefei,Anhui 230031,China)

机构地区：[1]安徽医科大学第一附属医院新生儿科,安徽合肥230031

出　　处：《中华医院感染学杂志》2021年第12期1791-1795,共5页Chinese Journal of Nosocomiology

基　　金：安徽省重点研究与开发计划基金资助项目(1701f0004042)。

摘　　要：目的分析2015-2019年82例新生儿败血症(NS)病原菌变化及临床特点,为临床诊断和治疗工作提供参考。方法选取2015年1月-2019年12月安徽医科大学第一附属医院收治的82例NS患儿作为研究对象,通过调取医院信息系统数据对其血培养病原菌分布、耐药性及临床特点进行回顾性分析。结果68例患儿经血培养确诊,血培养阳性率为82.93%,年度与患儿血培养阳性率之间无线性变化趋势。革兰阳性菌占比呈现逐年下降趋势,革兰阴性菌占比呈现出逐年上升趋势(P<0.05)。28例为早发型新生儿败血症(EONS),54例为晚发型新生儿败血症(LONS)。两类患儿出生体质量、新生儿窒息、羊水Ⅲ度污染、临床表现、白细胞计数、血小板计数水平、C-反应蛋白、呼吸机应用及发病日龄差异有统计学意义(P<0.05)。EONS患儿的感染性肺炎发生率高于LONS患儿(P<0.05);两类患儿其他并发症发生率和病死率的差异均无统计学意义。结论NS患儿的血培养病原菌出现革兰阴性菌占比上升、革兰阳性菌占比下降的趋势,EONS和LONS患儿在高危因素、临床表现、实验室指标、并发症发生率方面均具有一定的差异,临床应根据上述变化趋势和差异进一步优化NS的临床诊疗工作。OBJECTIVE To analyze the pathogenic bacteria changes and the clinical characteristics in 82 cases of neonatal sepsis(NS)from 2015 to 2019,so as to provide basis for clinical diagnosis and treatment.METHODS A total of 82 cases of NS children admitted to the First Affiliated Hospital of Anhui Medical University from Jan.2015 to Dec.2019 were selected as the research subjects.The distribution,drug resistance of blood culture pathogens and the clinical characteristics of the children were retrospectively analyzed through retrieving the hospital information system data.RESULTS 68 cases of children were diagnosed by blood culture,and the positive rate of blood culture was 82.93%,there was no linear change trend between the years and the positive rate of blood culture.The proportion of Gram-positive bacteria showed a downward trend year by year,and the constituent ratio of Gram-negative bacteria showed an upward trend year by year(P<0.05).There were 28 cases of early-onset neonatal sepsis(EONS)and 54 cases of late-onset neonatal sepsis(LONS).There were significant differences in birth weight,neonatal asphyxia,third degree amniotic fluid pollution,clinical manifestations,leukocyte count,platelet count,C-reactive protein,application of ventilator and age of onset between the two groups(P<0.05).The incidence of infectious pneumonia of the children with EOS was significantly higher than that of children with LONS(P<0.05).There was no significant difference in the incidence of other complications and mortality between the two groups.CONCLUSION Blood culture pathogenic bacteria in children with NS showed a trend of increasing in the proportion of Gram-negative bacteria and decreasing in the proportion of Gram-positive bacteria.There were some differences in risk factors,clinical manifestations,laboratory indicators and incidence of complications between EONS and LONS children.Clinical diagnosis and treatment of NS should be further optimized based on the above-mentioned trends and differences.

关 键 词：新生儿败血症 病原菌 临床特点 

分 类 号：R515.3[医药卫生—内科学]