18例早产儿真菌败血症临床特点

摘要

目的：对某院早产儿真菌败血症的临床特点进行分析，为临床诊治提供参考。方法对该院2011年1月—2013年12月18例早产儿真菌败血症的临床资料进行回顾性分析。结果18例早产儿胎龄为27～36周，出生体重为1050～3100 g，其中极低出生体重儿（VLBWI）8例；均有广谱抗菌药物用药史，感染前均长时间静脉营养，10例机械通气，2例经外周静脉穿刺中心静脉置管（PICC）。临床表现以呼吸暂停、抽搐、喂养困难、反应差等为主；出现症状时间为出生后3 h～52 d。13例（72．22％）早产儿血白细胞（WBC）计数异常，12例（66．67％）血小板（PLT）＜100×109／L ，18例（100．00％）C 反应蛋白（CRP）均增高，平均 CRP 浓度为（41．90±26．77）mg／L。感染病原菌以假丝酵母菌属为主，共17例（94．44％），其中包括近平滑假丝酵母菌7例，白假丝酵母菌5例，白假丝酵母菌生物变种4例，无名假丝酵母菌1例。用氟康唑及两性霉素 B 治疗，15例治愈（83．33％），2例好转（11．11％），1例死亡（5．56％）。结论早产儿真菌败血症以假丝酵母菌感染为主，临床缺乏特异性表现，应严密观察具有高危因素的早产儿临床症状，定期检测血常规及 CRP 等指标，及时给予抗真菌药物治疗，有助于取得良好的治疗效果。%Objective To analyze the clinical features of fungal septicemia in premature infants in a hospital,and provide reference for clinical diagnosis and treatment.Methods Clinical data of 18 premature infants with fungal septicemia in a hospital between January 2011 and December 2013 were analyzed retrospectively.Results Gesta-tional ages of 18 premature infants were 27-36 weeks,birth weights were 1 050 g-3 100 g,8 of whom were very low birth weight infants(VLBWI);all premature infants were treated with broad-spectrum antimicrobial agents,and were given long-term parenteral nutrition before infection,10 with mechanical ventilation,2 with peripherally insert-ed central catheters(PICC).The main clinical manifestations were apnoea,twitch,feeding difficulty,and poor reac-tion;manifestations appeared 3 hours-52 days after birth.13(72.22%)premature infants had abnormal white blood cell count,12 (66.67%)had thrombocytopenia (< 100 × 109/L),18 (100.00%)had elevated C-reactive protein (CRP),the average CRP level was (41 .90 ±26.77)mg/L.The main pathogens were Candida spp .(n = 17, 94.44%),including Candida parapsilosis (n=7),Candida albicans (n =5 ),biovariety of Candida albicans (n =4),and Candida famata (n=1);premature infants were treated with fluconazol and amphotericin B,15 (83.33%) were cured,2 (11 .11 %)improved,and 1 (5.56%)died.Conclusion Fungal septicemia in premature infants are mainly caused by Candida,there is no specific clinical manifestations,clinical symptoms in premature infants with high risk factors should be closely observed,blood routine and CRP should be detected periodically,timely treat-ment with antifungal agents should be given,which are beneficial to achieve good therapeutic effect.