目的 研究新生儿重症监护病房(SlCU)重症脓毒症临床流行病学特征.方法 回顾性调查2006年6月至2007年5月入住NICU患儿的病例资料,统计重症脓毒症的发生率、人口学特征、感染特点、病死率及死亡的危险因素等.结果 依据2005年颁布的国际儿科脓毒症诊断标准,本研究新生儿甭症脓毒症在NICU的发病率、病死率分别为19.8%(48/243)和45.8%(22/48),70.8%(34/48)系男性患儿;相对于其他危重病患儿,重症脓毒症病例的Apgar评分低、PRISM评分和病死率高.48名重症脓毒症患儿中,56.3%(27/48)有明确培养结果 ,大肠杆菌为最常检出的病原微生物;52.1%(25/48)患儿≥3个器官功能受损,最常见受累的是呼吸系统.重症脓毒症死亡危险因素的单因素分析发现PRISM评分高、功能障碍器官数目多、出现循环系统/血液系统/神经系统功能障碍的患儿死亡的相对危险度显著增加.结论 重症脓毒症是NICU中发生率高、病死率高的危重症,感染特征与国内外研究基本一致.多中心、大规模、不同年龄段的儿童承症脓毒症临床流行病学研究将有助于推动我国儿童脓毒症的规范诊治,提高新生儿危重病的治愈率.%Objective To determine the incidence and outcome of severe sepsis in Newborn Intensive Care Unit (NICU) and to characterize their demographics and infection pattern. Methods Characteristics of 243 newborns admitted to NICU from June Ist, 2006 to May 31th, 2007 were retrospectively analyzed. Results Analysis of data derived from 243 newborns admitted to NICU over an 1-year period with 48 ( 19. 8% ) cases diagnosed as severe sepsis, and 70. 8% of them were males. The median age of severe sepsis patients was 2 (1-6) days. In 56.3% of the patients bacteria were isolated, and E. Coli was the predominant microbe. PRISM score and mortality rate were higher in those with severe sepsis,while their Apgar score was lower than other cases. The overall hospital mortality of severe sepsis was 45.8%. Risk factors for hospital mortality included higher PRISM score, severe organ dysfunction, circulatory system dysfunction, and hematological or central nervous system dysfunction. Conclusions This study shows that severe sepsis is a common, frequently fatal morbid condition in critical ill newborns in NICU, showing similar disease pattern with other investigations. Further multiple-center investigations are helpful to prevent, control and salvage critically ill children suffering from severe sepsis.
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