新生儿败血症229例临床特点、病原学分布及转归分析

摘要

目的 分析新生儿败血症的临床特点、病原学及转归等资料,探讨早发型败血症及晚发型败血症患儿的特点,以期对新生儿败血症的早期诊治提供临床依据.方法 选取2013年6月至2016年6月中国医科大学附属盛京医院第一新生儿内科病房收治的229例败血症患儿,按起病时间分为早发型败血症(EOS)和晚发型败血症(LOS),采用SPSS 20.0统计学软件对2组患儿的一般情况、临床表现、实验室检查、病原分布、并发症及转归等进行对比分析,多因素分析采用Logist 逐步回归.结果 EOS组68例(29.69％),以体质量正常的足月儿多见[35例(51.5％)];LOS组161例(70.31％),以极低出生体质量的早产儿多见[84例(52.2％)].母亲妊娠期高血压、出生后机械通气(气管插管)、留置经外周插管的中心静脉导管(＞5 d)、出生后静脉营养(＞3 d)与败血症的发生密切相关(均P ＜0.05).EOS组以发热和黄疸多见,易并发细菌性脑膜炎;LOS组以呼吸暂停和腹胀多见,易并发新生儿坏死性小肠结肠炎.2组患儿血小板、C反应蛋白(CRP)等实验室检测指标比较差异均无统计学意义(均P＞0.05).CRP联合降钙素原(PCT)诊断败血症的敏感度更高.EOS以革兰阳性菌为主,其中凝固酶阴性葡萄球菌(CoNS)更为常见[26.5％(18/68例)],LOS以革兰阴性菌为主,主要病原为肺炎克雷伯杆菌[53.4％(86/161例)].EOS组病死率[7.4％(5/68例)]明显高于LOS组[2.5％(4/161例)],但2组比较差异无统计学意义(x2=4.72,P＞0.05).结论 败血症患儿因其发病时间不同,在临床特点、病原学分布及转归上表现出一定差异.EOS以足月儿多见,LOS以早产儿较常见;围生期和出生后存在各种导致败血症的高危因素,早期识别高危因素对败血症的防治至关重要.早期及时诊断对降低败血症患儿的病死率具有重要意义.%Objective To analyze the clinical features,etiology and outcome of neonatal sepsis,and to clarify the characteristics of early-onset sepsis and late-onset sepsis,which may provide clinical evidence for early diagnosis and treatment of neonatal sepsis.Methods Two hundred and twenty-nine cases of neonatal sepsis who were hospitalized in the First Neonatal Wards,Shengjing Hospital Affiliated to China Medical University First Neonatal Wards from June 2013 to June 2016,and according to the onset time,they were divided into the early-onset sepsis (EOS) group and the late-onset sepsis(LOS) group,and SPSS 20.0 statistical software was used for comparative analysis of the data concerning the general situation,clinical manifestation,laboratory examination,pathogen distribution,complications and outcome between 2 groups,and Logistic stepwise regression was used to detect multiple factors.Results Sixty-eight patients (29.69％) were in the EOS group,and among them the full-term infants with normal weight accounted for 51.5％;161 cases (70.31％) were in the LOS group with extremely low birth weight premature infants occupying 52.2％.The mothers with gestational hypertension,after the birth of mechanical ventilation,parenteral nutrition (＞3 d),indwelling peripherally inserted central catheters (＞ 5 d) had significant correlations with sepsis (all P ＜0.05).They had fever and jaundice,complicated with purulent meningitis in the EOS group.The apnea and abdominal distension seemed more easily complicated with necrotizing enterocolitis in the LOS group.There as no difference in laboratory test indexes such as platelet,C-reactive protein (CRP) (all P ＞ 0.05).Procalcitonin and CRP had higher sensitivity in the diagnosis of sepsis.EOS was given priority to Gram-positive bacteria,which was far more common coagulase negative staphylococcus [26.5％ (18/68 cases)],and LOS was due to mainly Gram-negative bacteria and the main pathogens were klebsiella pneumoniae in 86 cases (53.4％).The mortality in the EOS group was significantly higher than that in the LOS group[7.4％ (5/68 cases) vs.2.5％ (4/161 cases)],but the difference was not statistically significant (x2 =4.72,P ＞ 0.05).Conclusions Because time of neonatal sepsis onset time is different,the clinical characteristics,the distribution of etiology and outcome also show some differences,and full-terms often have EOS which is more common in the premature babies with LOS.There are various high risk factors for sepsis in perinatal and postnatal period.Therefore,early and timely diagnosing the neonatal sepsis has great significance in reducing the mortality of neonatal sepsis.