本文關鍵詞： 新生兒 敗血癥 臨床特點 細菌培養(yǎng) 藥敏實驗　出處：《重慶醫(yī)科大學》2012年碩士論文　論文類型：學位論文

【摘要】：目的：總結新生兒敗血癥的臨床特點、細菌培養(yǎng)陽性率、常見病原菌及其耐藥情況，比較早、晚發(fā)新生兒敗血癥高危因素、局部感染發(fā)生率、合并癥及各種病原菌感染率。 方法：回顧性分析2010年9月至2011年8月我科收治的171例新生兒敗血癥的臨床資料，統(tǒng)計分析新生兒敗血癥的常見高危因素、臨床表現(xiàn)、局部感染發(fā)生率、合并癥及病原學特點；按發(fā)病年齡將其分為早、晚發(fā)新生兒敗血癥兩組，對高危因素、局部感染發(fā)生率、病原菌感染率進行比較分析。 結果：早產(chǎn)、低出生體重、母羊水發(fā)臭或糞染、宮內(nèi)窘迫、生后窒息、氣管插管為早發(fā)新生兒敗血癥高危因素。新生兒敗血癥臨床表現(xiàn)常不典型，以活動減少或嗜睡（63.4%）、皮膚黃疸（57.3%）、少吃（41.5%）、發(fā)熱（39.8%）所占比例較高。最常見伴隨局部感染為呼吸道感染（91.2%），其次為皮膚粘膜感染（28.1%），比較早、晚發(fā)新生兒敗血癥兩組的皮膚黏膜感染率有顯著統(tǒng)計學差異（P＜0.05）。該組病例99.4%合并有其他疾病，其中新生兒病理性黃疸（49.1%）最為常見。171例新生兒敗血癥患兒，細菌培養(yǎng)陽性率為49.1%，革蘭陽性菌占74.1%，其中CONS占總菌株的55.3%，MRS占49.4%；革蘭陰性菌占23.5%，其中產(chǎn)ESBLs革蘭陰性菌共占總菌株的11.8%；真菌占2.4%。早、晚發(fā)兩組新生兒敗血癥革蘭陽性菌的感染率有顯著統(tǒng)計學差異（P＜0.05）。青霉素類、紅霉素、頭孢西丁、苯唑西林、復方新諾明等對葡萄球菌的敏感度較低，，萬古霉素對革蘭陽性球菌完全敏感；青霉素類、一代頭孢、氨曲南等對革蘭陰性均敏感度較低，三代頭孢對革蘭陰性菌的敏感度有降低趨勢；阿米卡星對于革蘭陽性菌和革蘭陰性菌包括產(chǎn)ESBLs均有較好的敏感性。 結論：早產(chǎn)、低出生體重、母羊水發(fā)臭或糞染、宮內(nèi)窘迫、生后窒息、氣管插管為早發(fā)新生兒敗血癥高危因素。新生兒敗血癥往往伴隨局部感染及各種合并癥。早發(fā)及晚發(fā)新生兒敗血癥伴隨局部感染的部位有顯著統(tǒng)計學差異。我院新生兒科細菌培養(yǎng)陽性率較高，致病菌以革蘭陽性菌為主，尤其CONS等條件致病菌仍是新生兒敗血癥主要致病菌。青霉素類、紅霉素、一代頭孢、頭孢西丁、苯唑西林、氨曲南、復方新諾明等耐藥率較高，已不適合作為新生兒敗血癥首選藥物。
[Abstract]:Objective: to summarize the clinical characteristics of neonatal septicemia, the positive rate of bacterial culture, the common pathogens and their drug resistance, the high risk factors of early and late neonatal septicemia, the incidence of local infection, the complication and the infection rate of various pathogens. Methods: the clinical data of 171 cases of neonatal septicemia from September 2010 to August 2011 were analyzed retrospectively. The common high risk factors, clinical manifestations and local infection rate of neonatal septicemia were statistically analyzed. According to the age of onset, the patients were divided into two groups: early and late neonatal septicemia. The high risk factors, the incidence of local infection and the infection rate of pathogenic bacteria were compared and analyzed. Results: premature delivery, low birth weight, stinking or fecal contamination of ewe, intrauterine distress, postnatal asphyxia, tracheal intubation were the high risk factors for premature neonatal sepsis. The clinical manifestations of neonatal septicemia were often atypical. The most common local infection was respiratory tract infection (91.2%), followed by skin mucosal infection (28.1%), and skin mucosal infection (28.1%). There was significant difference in the infection rate of skin and mucous membrane between the two groups (P < 0.05). In this group, 99.4% cases were complicated with other diseases, among which 49.1 cases of neonatal pathological jaundice were the most common cases of neonatal septicemia. The positive rate of bacterial culture was 49.1%, Gram-positive bacteria accounted for 74.1%, of which CONS accounted for 55.3% of the total strains and Mrs accounted for 49.4%; Gram-negative bacteria accounted for 23.5% of the total strains; Gram-producing gram-negative bacteria accounted for 11.8% of the total strains; fungi accounted for 2.40.Morning. There was significant difference in the infection rate of Gram-positive bacteria between the two groups (P < 0.05). The sensitivity of penicillin, erythromycin, cefoxitin, oxacillin and compound sulfamine to staphylococcus was low. Vancomycin was completely sensitive to gram-positive cocci, penicillin, cephalosporins and aztreonam were less sensitive to gram-negative bacteria, and the sensitivity of the third generation cephalosporins to gram-negative bacteria tended to decrease. Amikacin was sensitive to Gram-positive bacteria and Gram-negative bacteria, including ESBLs production. Conclusion: premature delivery, low birth weight, stink or fecal contamination of ewe water, intrauterine distress, postnatal asphyxia, Endotracheal intubation is a high risk factor for premature neonatal sepsis. Neonatal septicemia is often associated with local infection and various complications. There is significant statistical difference between early and late neonatal septicemia associated with local infection in our hospital. The positive rate of bacterial culture in pediatric patients was high. The main pathogenic bacteria were Gram-positive bacteria, especially CONS. Penicillin, erythromycin, cephalosporins, cefoxitin, oxacillin, aztreonam, and compound sulfamine were still the main pathogens of neonatal septicemia, and the resistance rates of penicillin, erythromycin, oxacillin, aztreonam and compound sulfamine were high. Is no longer suitable for neonatal sepsis as the preferred drug.
【學位授予單位】：重慶醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2012
【分類號】：R722.1

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