本文選題：新生兒 + 感染��； 參考：《重慶醫(yī)科大學》2012年碩士論文

【摘要】：目的：了解中法兩國對早發(fā)型新生兒膿毒血癥（early-onsetneonatal sepsis, EONS）在臨床表現(xiàn)、診斷、治療方面的不同，為提高我院對EONS的診治水平提供依據(jù)。 資料與方法：對法國斯特拉斯堡大學hautepierre醫(yī)院婦女兒童中心和重慶醫(yī)科大學附屬兒童醫(yī)院共146例EONS患兒的細菌譜、臨床表現(xiàn)、抗菌藥使用、產(chǎn)前危險因素記錄和篩查情況進行回顧性分析。 結(jié)果：我院常見致病菌為凝固酶陰性葡萄球菌（69.2%），大腸桿菌（15.4%），肺炎克雷伯菌（7.7%）和棲息微球菌（7.7%）；hautepierre醫(yī)院為B族鏈球菌（33.3%），大腸桿菌（33.3%），凝固酶陰性葡萄球菌（16.7%）和莫拉氏菌（16.7%）。Hautepierre醫(yī)院胃液和周圍拭子培養(yǎng)常見大腸桿菌（33.3%），B族鏈球菌（21.2%），凝固酶陰性葡萄球菌（18.2%）等。我院抗菌藥使用總天數(shù)（11.4±7.2d）、平均每個患兒抗菌藥使用的種類（3.1±0.9）和換抗菌藥人數(shù)比例（70.2%）均大于hautepierre醫(yī)院（6.2±2.5d，2.2±0.8，9.9%）。兩院首劑抗菌藥常用二聯(lián)組合（我院二代頭孢+半合成青霉素，hautepierre醫(yī)院阿莫西林+阿米卡星）。我院二、三線抗菌藥常見碳青霉烯類和萬古霉素，hautepierre醫(yī)院常見三代頭孢和萬古霉素。我院對多種產(chǎn)前危險因素（絨毛膜羊膜炎、母親發(fā)熱、破膜到胎兒娩出時間、孕期是否行陰道拭子或尿路感染情況、羊水污染、產(chǎn)前抗菌藥使用、EONS的既往史）的記錄率均低于hautepierre醫(yī)院；羊水污染、破膜時間是否延長和宮內(nèi)窘迫情況篩查陽性率兩院有差異。在生后立即出現(xiàn)異常而入院的患兒中，兩院最常見的異常均為呼吸困難（96.5%vs.88.2%）；在生后一段時間出現(xiàn)異常的患兒中，兩院常見入院原因構(gòu)成比不同：我院常見原因為呼吸困難（44.4%），反應差（22.2%）等；hautepierre醫(yī)院常見原因為C反應蛋白升高（78.2%），發(fā)熱（5.5%）等。兩所醫(yī)院CRP診斷早發(fā)型新生兒膿毒血癥的假陰性率無統(tǒng)計學差異。 結(jié)論：重視產(chǎn)前危險因素的篩查與記錄、促進與產(chǎn)科的合作可提高我院對EONS患兒的早期診斷的準確性，積極尋找病原菌和藥敏試驗可能減少換藥次數(shù)和抗菌藥使用時間。我國仍需大樣本、多中心的研究來確定劃分早發(fā)和晚發(fā)型新生兒膿毒血癥的必要性和具體分界點，并完善膿毒血癥經(jīng)驗抗菌藥使用的臨床指南，也需要更多的關于我國與歐洲國家在EONS診治方面的對比性研究。
[Abstract]:Objective: to investigate the differences of clinical manifestations, diagnosis and treatment between China and France in the treatment of early onset neonatal sepsis (EONSs), and to provide a basis for improving the level of diagnosis and treatment of EONS in our hospital. Materials and methods: the bacterial spectrum, clinical manifestations and antimicrobial use of 146 children with EONS were collected from the Women's and Children's Center of hautepierre Hospital, University of Strasbourg, France and the affiliated Children's Hospital of Chongqing Medical University. Antepartum risk factors were recorded and screened for retrospective analysis. Results: the common pathogenic bacteria in our hospital were coagulase negative staphylococci 69.2, Escherichia coli 15.4 and Klebsiella pneumoniae 7.7. and Micrococcus pernica 7.7. hautepierre Hospital: group B streptococcus 33. 3%, Escherichia coli 33. 33%, coagulase negative Staphylococcus 16. 775) and Mora's fungus 16. 777. Hautepierre Common Escherichia coli was cultured in gastric juice and peripheral swabs in hospital. The bacteria of Streptococcus sp. B was 21.2and coagulase negative staphylococcus was 18.2and so on. The total number of days of use of antibiotics in our hospital was 11.4 鹵7.2 days, the average number of antibiotics used per child was 3.1 鹵0.9) and the ratio of the number of patients who changed antibiotics was 70.2), which was higher than that in hautepierre hospital (6.2 鹵2.5 days, 2.2 鹵0.8, 9.9g). Amoxicillin Amikacin, second generation cephalosporin semi-synthetic penicillin, amoxicillin Amikacin, Amoxicillin Amikacin Hospital, our hospital. Common carbapenems and vancomycin in the second and third-line antimicrobial agents of our hospital are common in the third generation of cephalosporins and vancomycin. The risk factors (chorioamnionitis, febrile mother, time between rupture and delivery of fetus, vaginal swab or urinary tract infection during pregnancy, amniotic fluid contamination) were analyzed in our hospital. The record rate of antepartum antibiotics use EONS was lower than that of hautepierre hospital, amniotic fluid pollution, membrane breaking time prolongation and positive rate of intrauterine distress screening were different. The most common abnormalities in both houses of children who were admitted to the hospital immediately after birth were dyspnea 96.5a and vs.88.2e.In those who had been abnormal for some time after birth, the most common abnormalities in both houses were dyspnea. The common causes of hospitalization in both houses were different: the common causes in our hospital were dyspnea (44.4am), poor response (22.2) and so on. The common causes were C-reactive protein elevation (78.2%), fever (5.5%) and so on. There was no significant difference in false negative rate of CRP in early onset neonatal sepsis between the two hospitals. Conclusion: attention should be paid to the screening and recording of prenatal risk factors and cooperation with obstetrics can improve the accuracy of early diagnosis of EONS children in our hospital. Actively searching for pathogenic bacteria and drug sensitivity tests may reduce the times of changing drugs and the time of using antimicrobial drugs. China still needs a large sample and multi-center study to determine the necessity and specific demarcation points for distinguishing early and late onset neonatal sepsis, and to perfect the clinical guidelines for the use of antibiotics in sepsis experience. There is also a need for more comparative research on EONS diagnosis and treatment between China and European countries.
【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】：R722.13

【參考文獻】

相關期刊論文 前3條

1 柏進;楊娟;韓雪花;錢瑋和;;新生兒敗血癥早發(fā)型與晚發(fā)型病原菌及其藥敏分析[J];山東醫(yī)藥;2010年17期

2 肖群文;梁琨;賀湘英;李琪;徐靜;段江;;胃液檢查在新生兒早期細菌感染診斷中的應用[J];實用兒科臨床雜志;2007年14期

3 楊東霞;分娩前產(chǎn)婦陰道及新生兒體表菌群調(diào)查[J];社區(qū)醫(yī)學雜志;2005年07期

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