通过临床评估早期诊断早产儿院内感染的初步探讨  

Early diagnosis of the premature infant nosocomial infection by clinical assessment

作　　者：祁俊明[1] 丁国芳[1] 

机构地区：[1]中国医学科学院中国协和医科大学北京协和医院儿科,100730

出　　处：《中华儿科杂志》2003年第12期889-892,共4页Chinese Journal of Pediatrics

摘　　要：目的　探讨用临床表现及实验室检查评分的方法判断早产低出生体重儿院内细菌感染的可能性。方法　将研究对象按现行新生儿感染的诊断标准分为感染组 (A组 )及对照组 (B组 ) ,按照临床表现的严重程度及临床常用实验室检查结果予以综合性评分 ,并以有效抗生素治疗后进行对照 ,分别对组间及组内的评分进行比较。结果　治疗前 2 4hA组评分大于B组 ,两组评分之间差异有显著性 (P <0 0 1) ,有效抗生素治疗后A组与B组评分之间差异无显著性 (P >0 0 5 )。在A组治疗前与治疗后评分差异有显著性 (P <0 0 1)。B组中≥ 11分者在抗生素治疗后评分下降 ,并与治疗前比较差异有显著性 (P <0 0 1) ;<11分者差异无显著性。提示现行诊断新生儿感染的标准 ,对早产儿及胎龄小的极低出生体重儿不敏感。结论　对早产儿及低出生体重儿进行临床综合评分 ,有利于判断患儿感染的可能性 ,并可监测抗感染治疗的有效性。Objective To study the possibility of bacterial infections in the hospital among the premature and low birth weight newborns by scoring their clinical assessments and laboratory examinations. Methods From January 2002 to January 2003, 62 newborns with birth-weight less than 2 000 g were divided into two groups, infected group and control group, based on the current diagnostic standards for newborns. We scored the newborns according to the severity of their illnesses based on their clinical manifestations and laboratory examination, and compared the scores obtained before and after effective antibiotic treatment.Results It was found that the scores were significantly different ( P <0.01) between the infected group and the control group before treatment; while after antibiotic treatment, the difference was no longer significant ( P >0.05). In the infected group, the scores obtained pre-and post-treatment were significantly different ( P <0.01). In the control group, in those with the scores ≥11 before antibioctic treatment, the scores significantly decreased ( P <0.01) after-treatment; but in those with the scores <11, the score did not decrease( P >0.05). These results indicate that the current diagnostic criteria for newborns may not be sensitive enough for premature infants, low birth weight infants and very low birth weight infants.Conclusion Scoring the low birth weight premature infants with their clinical manifestations has the advantages in judging the possibility of infection and monitoring the effectiveness of the anti-infection treatment.

关 键 词：临床评估 早期诊断 早产儿 院内感染 

分 类 号：R722.6[医药卫生—儿科]