本文選題：膿毒癥 + 菌血癥　； 參考：《北京大學(xué)學(xué)報(bào)(醫(yī)學(xué)版)》2017年05期

【摘要】：目的:探討新生兒真菌敗血癥的臨床特點(diǎn),并與新生兒細(xì)菌敗血癥的臨床特點(diǎn)進(jìn)行比較,提高對新生兒真菌敗血癥的認(rèn)識。方法:選取2011—2016年北京大學(xué)第一醫(yī)院新生兒重癥監(jiān)護(hù)病房中收治的新生兒真菌敗血癥患兒的臨床資料進(jìn)行回顧性分析,同時(shí)選取同期住院的新生兒細(xì)菌敗血癥患兒,對兩組患兒的臨床特點(diǎn)進(jìn)行比較。結(jié)果:共納入新生兒真菌敗血癥患兒15例,真菌敗血癥發(fā)生情況為0.52%,極低出生體重兒為2.5%。臨床表現(xiàn)非特異,所有患兒應(yīng)用腸外營養(yǎng)、廣譜抗生素,13例患兒留置外周放置中心靜脈導(dǎo)管(peripheral inserted central venous catheter,PICC)。病原學(xué)分析顯示,光滑假絲酵母菌(Candida glabrata)占第一位,對二性霉素B均敏感,一株光滑假絲酵母菌對氟康唑耐藥。與同期34例新生兒細(xì)菌敗血癥患兒比較,真菌敗血癥組的血小板計(jì)數(shù)明顯低于細(xì)菌敗血癥組(61×109/L vs.178×109/L,P=0.004),血小板下降比例明顯高于細(xì)菌敗血癥組(80.0%vs.29.4%,P=0.001),留置PICC比例高于細(xì)菌敗血癥組(86.7%vs.55.7%,P=0.037)。受試者工作特征曲線(receiver operating characteristic curve,ROC曲線)分析發(fā)現(xiàn),以血小板計(jì)數(shù)145×109/L為界值時(shí),預(yù)測新生兒真菌敗血癥的敏感度和特異度分別為61.8%和92.9%。經(jīng)規(guī)范的抗真菌治療后,真菌敗血癥患兒均治愈,血小板恢復(fù)正常,肝、腎功能未見明顯變化。結(jié)論:新生兒真菌敗血癥的臨床表現(xiàn)呈非特異性,病原以光滑假絲酵母菌占第一位,給予規(guī)范治療療效較好,血小板降低和留置PICC可能提示真菌感染。
[Abstract]:Objective: to explore the clinical characteristics of neonatal fungal septicemia and compare it with neonatal bacterial septicemia to improve the understanding of neonatal fungal septicemia. Methods: the clinical data of neonates with fungal septicemia admitted in the neonatal intensive care unit of the first Hospital of Peking University from 2011 to 2016 were retrospectively analyzed. The clinical characteristics of the two groups were compared. Results: a total of 15 neonates with fungal septicemia were included. The incidence of fungal septicemia was 0.52and that of very low birth weight infants was 2.5. The clinical manifestations were nonspecific. All the children were treated with parenteral nutrition. Thirteen patients with broad-spectrum antibiotics were placed in peripheral venous catheterization with central inserted central venous catheterization. The pathogen analysis showed that Candida glabrata was the most sensitive to diamicin B, and a Candida glabrata was resistant to fluconazole. Compared with 34 neonates with bacterial septicemia in the same period, the platelet count in fungal septicemia group was significantly lower than that in bacterial septicemia group (61 脳 10 ~ 9 / L vs.178 脳 10 ~ (9 / L) P ~ (0.004), and the percentage of platelet decline was significantly higher than that in bacterial septicemia group (n = 80.0vs.29.4P ~ + 0.001). The percentage of indwelling PICC was higher than that in bacterial septicemia group (86.7vs.55.7V). The sensitivity and specificity of predicting neonatal fungal septicemia were 61.8% and 92.9%, respectively, when the platelet count was taken as the threshold value of 145 脳 10 ~ 9 / L, the receiver operating characteristic curved-ROC curve showed that the sensitivity and specificity of predicting neonatal fungal septicemia were 61.8% and 92.9%, respectively. After standard antifungal therapy, all the children with mycosepticemia were cured, platelets returned to normal, and liver and kidney function did not change obviously. Conclusion: the clinical manifestations of neonatal fungal septicemia are nonspecific, the first pathogen is Candida lucidum, and the standard treatment is better. The decrease of platelet and the indwelling of PICC may suggest fungal infection.
【作者單位】： 北京大學(xué)第一醫(yī)院兒科;
【分類號】：R722.131

【相似文獻(xiàn)】

相關(guān)期刊論文 前5條

1 董青藝;陳平洋;謝宗德;賀曉日;李雯;趙子艷;;新生兒真菌敗血癥22例臨床分析[J];中國實(shí)用兒科雜志;2010年05期

2 代紀(jì)娟;鄭雪明;王俊琳;;血漿1,3-β-D葡聚糖檢測診斷新生兒真菌敗血癥的臨床價(jià)值[J];山東醫(yī)藥;2012年45期

3 王巧芳;李琳;陳麗萍;何玲;;新生兒真菌敗血癥11例臨床分析[J];實(shí)用臨床醫(yī)學(xué);2012年10期

4 安靜;;17例早產(chǎn)兒真菌敗血癥的臨床分析[J];中國城鄉(xiāng)企業(yè)衛(wèi)生;2011年03期

5 程憲,黃玉春,邊興艷;早產(chǎn)兒真菌敗血癥伴腦膜炎一例[J];小兒急救醫(yī)學(xué);2003年05期

相關(guān)會議論文 前1條

1 馬紅秋;;新生兒真菌敗血癥醫(yī)院感染預(yù)防與控制[A];中國醫(yī)院協(xié)會第十八屆全國醫(yī)院感染管理學(xué)術(shù)年會論文資料匯編[C];2011年

相關(guān)碩士學(xué)位論文 前1條

1 徐豆豆;新生兒重癥監(jiān)護(hù)病房內(nèi)早產(chǎn)兒真菌敗血癥臨床分析[D];安徽醫(yī)科大學(xué);2015年

，

本文編號：1901940