重症监护病房新生儿深部真菌感染临床特点分析

摘要

目的 提高新生儿深部真菌感染的临床诊断及经验性治疗水平.方法 选取2008年1月 - 2010年12月期间NICU住院确诊深部真菌感染的21例新生儿为研究对象,分析患儿的临床表现、实验室结果、基础疾病、真菌类别,以及抗真菌治疗效果.结果 患儿基础疾病以肺部疾病最多见,占47.6%;外科手术治疗5例,占23.8%,其中腹部手术者4例.临床表现以喂养不耐受、呼吸暂停、发热和反应差最多见,有19例(90.5%)出现血小板减低,19例(90.5%)超敏CRP增高,白细胞正常13例(61.9%).其中确诊真菌败血症18例(85.7%),真菌脑炎1例(4.8%),尿路感染2例(9.5%).病原菌均为假丝酵母菌.用氟康唑及两性霉素B脂质体治疗,总治愈率71.4%,好转19.1%,死亡9.5%.结论 喂养不耐受、发热、呼吸暂停和反应差是深部真菌感染患儿最多见的临床表现;患儿多数表现有血小板减低及超敏CRP增高,白细胞正常不能排除该病;近平滑假丝酵母菌感染最多见,白假丝酵母菌次之.%Objective To enhance the clinical diagnosis and empirical treatment for invasive fungal infection (IFI) in neonates.Methods Twenty-one neonatal intensive care unit (NICU) patients diagnosed with IFI between Jan.2008 and Dec.2010 were retrospectively reviewed.Their clinical signs, laboratory findings, basal illnesses, fungus species and efficacy of anti-fungal treatment were analyzed.Results The most common basal illness was lung disease;second was surgery, among which 4 cases were abdominal surgery.Feeding intolerance, apnea, hyperthermia and delayed response were the most common presenting signs.The laboratory findings showed 19 cases of platelet (PLT)decrease (90.5％), 19 cases of C-reactive protein (CRP) increase (90.5％) and 13 cases of normal white blood count (WBC) (61.9％).The fungal infections included 18 cases of sepsis (85.7％), 1 case of meningitis (4.8％) and 2 cases of urinary tract infection (9.5％).Cadida parapsilosis was the leading causative pathogen of IFI.All the IFI patients were treated with the combination of fluconazole and amphotericin B, with 71.4％ of cure, 19.1％ of improvement and 9.5％of mortality.Conclusions Feeding intolerance, hyperthermia, apnea and delayed response are the most common presenting signs for IFI.PLT decrease and CRP increase are the most common laboratory findings for IFI, and a normal WBC does not rule out IFI.Candida parapsilosis is the leading causative pathogen of IFI in neonates, Calbicans is the next.