新生儿内源性眼内炎的临床特征  

Clinical features of neonatal endogenous endophthalmitis

作　　者：蒋弘杨 邓铂林 董文韬[1] Jiang Hongyang;Deng Bolin;Dong Wentao(Department of Ophthalmology,Sichuan Provincial People's Hospital,University of Electronic Science and Technology of China,Chengdu 610072,China)

机构地区：[1]电子科技大学附属医院四川省人民医院,成都610072

出　　处：《临床眼科杂志》2024年第1期21-25,共5页Journal of Clinical Ophthalmology

基　　金：四川省科技计划项目(2022YFS0234);四川省人民医院青年科研基金(2017QN02);电子科技大学中央高校基金(2672018ZYGX2018J098)。

摘　　要：目的观察新生儿内源性眼内炎的临床特征。方法回顾性病例研究。选取2010年7月至2022年7月在四川省人民医院眼科就诊的新生儿内源性眼内炎(NEE)患者21例(27只眼)为研究对象。包括男性9例(12只眼),女性12例(15只眼);出生孕周(30±4.6)周(23~38周);出生体重(1463.6±920.4)g(640~3800 g)。所有患儿均行眼前节、眼底和实验室检查。详细收集患者年龄、性别、出生体重、出生孕周、专科检查、实验室检查、治疗方案等临床资料。以首次检查时的眼部症状将NEE被分为以下两种类型:局灶型,表现为眼前节正常,眼底检查可见视网膜黄白色团块状病灶;暴发型,以角膜混浊、前房渗出、前房积脓等为主要表现。随访5~23个月,观察患儿眼部病变特征、全身合并疾病、致病菌及治疗转归情况。结果21例NEE患者中,出生孕周在32周以下的患者15例(71.4%),出生体重在2000 g以下的患者16例(76.2%)。平均发病时间为出生后(4±4.6)周(1~20周),17例(81%)在出生后4周内发病。以首次检查时的眼部症状将NEE分型:局灶型2眼(7.4%),均在常规眼底筛查时发现视网膜黄白色团块状病灶;暴发型25眼(92.6%),均在发现眼睑红肿、结膜充血、角膜混浊、前房积脓等明显感染症状后转诊至眼科进行治疗。21例NEE患者常见相关全身合并症依次是:败血症(47.6%,10/21)、脑膜炎(33.3%,7/21)、休克(28.6%,6/21)、呼吸障碍(23.8%,5/21)。在21例NEE患者中有19例(90.5%)培养阳性,最常见的致病菌是铜绿假单胞菌(31.6%,6/19)。全身联合玻璃体腔内注射抗生素/抗真菌药物是最常见的治疗方法(18眼,66.7%),12眼(44.4%)在抗生素/抗真菌药物治疗后接受了手术治疗。经治疗,14例(17只眼)(63%)最终死亡或丧失视力。7例(10只眼),37%的最终视力得以保留。结论NEE通常发生在出生后4周内,角膜混浊、前房积脓是最常见的眼部表现;暴发型NEE预后差,早期玻璃体切除联合抗�Objective To observe the ocular clinical features of neonatal endogenous endophthalmitis(NEE).Methods A retrospective case series study.27 eyes of 21 newborns(12 eyes in 9 males and 15 eyes in 12 females)with NEE who visited department of ophthalmology of Sichuan Provincial People's Hospital From July2010 to July 2022were in⁃cluded in the study.Gestational age at birth was23~38(30±4.6)weeks.Birth weight was640~3800(1463.6±920.4)g.All patients underwent anterior segment,fundus and laboratory examination.Clinical data such as age,sex,birth weight,gestational weeks,ophthalmic examination,laboratory examination and treatment were collected in detail.According to the ocular symptoms at the first examination,NEE was divided into the following two types:focal type,showing yellow and white localized lesions in the fundus,and fulminant type,with corneal opacity,anterior chamber exudation,hyphema as the main manifestations.The follow-up period was from 5 to 13 months,and the characteristics of eye lesions,systemic comor⁃bid diseases,pathogenic bacteria and treatment outcomes were observed.Results Among the 21 patients with NEE,15(71.4%)with gestational age less than 32 weeks and 16(76.2%)had a birth weight of less than 2000 g.The mean onset time was 1~20(4±4.6)weeks,and 17 cases(81%)developed NEE within 4 weeks after birth.According to the ocular symptoms at the first detection,NEE were divided into the following two types.Focal type in 2 eyes(7.4%),usually found in routine screening.The manifestation was retinal yellow white lumpy lesions.25 eyes(92.6%)of fulminant type were re⁃ferred to ophthalmology for treatment after obvious infection symptoms such as eyelid swelling,conjunctival injection,cor⁃neal opacity,and hyphema were found.The common systemic diseases of 21 patients with nee were sepsis(47.6%,10/21),meningitis(33.3%,7/21),shock(28.6%,6/21),and respiratory disturbance(23.8%,5/21).There were 19(90.5%)patients,culture positive,and the most common pathogenic bacteria was Pseudomonas aeruginosa(31.6%,6/19)

关 键 词：新生儿 内源性眼内炎 铜绿假单胞菌 玻璃体腔内注射抗生素 玻璃体切除术 败血症 

分 类 号：R722.1[医药卫生—儿科] R771[医药卫生—临床医学]