本文選題：新生兒敗血癥 + 早發(fā)型��； 參考：《重慶醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的：分析比較新生兒早發(fā)型敗血癥(early-onset neonatal septicemia, EOS)和新生兒晚發(fā)型敗血癥(late-onset neonatal septicemia, LOS)的臨床特點(diǎn)、非特異性指標(biāo)、病原菌分布及藥敏情況,以指導(dǎo)臨床診斷和治療。方法：選取血培養(yǎng)陽性新生兒敗血癥患兒352例,根據(jù)發(fā)病時(shí)間將其分為早發(fā)型敗血癥和晚發(fā)型敗血癥,對其臨床資料進(jìn)行回顧性分析比較。結(jié)果：352例新生兒敗血癥中早發(fā)型144例(40.91%),晚發(fā)型208例(59.09%),且晚發(fā)型敗血癥中有108例(51.92%)為院內(nèi)感染。早發(fā)型敗血癥多發(fā)生于足月兒[107/144例(74.31%)],晚發(fā)型敗血癥多發(fā)生于早產(chǎn)兒[77/208例(37.02%)]及低出生體質(zhì)量兒[70/208例(33.65%),x2=4.123,P0.05]。早發(fā)型敗血癥新生兒窒息[21/144例(14.58%)]、宮內(nèi)窘迫[14/144例(9.72%)]、羊水糞染[26/144例(18.06%)]、胎膜早破≥18h[31/144例(21.53%)]的比例高于晚發(fā)型[分別為17/208例(8.17%)、9/208例(4.33%)、13/208例(6.25%)、17/208例(8.17%),x2值分別為4.622、3.886、5.950、13.345,P均0.05。晚發(fā)型敗血癥出現(xiàn)體溫異常[72/208例(34.62%)]、嘔吐或腹脹[109/208例(39.42%)]、少吃少哭少動(dòng)癥狀[79/208例(37.98%)]、臍炎或膿皰或皮膚破潰[33/208例(15.87%)]的比例大于早發(fā)型[分別為30/144例(20.83%)、35/144例(24.31%)、38/144例(26.39%)、11/144例(7.64%)x2值分別為7.853、66.116、5.153、5.265,P均0.05]。晚發(fā)型敗血癥高I/T值[27/184例(14.67%)]、CRP升高[76/206例(36.89%)]的比例明顯高于早發(fā)型敗血癥[分別為9/133例(6.77%)、38/143例(26.57%)，，x2值分別為4.794、4.087,P均0.05]。晚發(fā)型敗血癥患兒更易發(fā)生細(xì)菌性腦膜炎[37/208例(17.79%)比12/144例(8.33%)；x2=6.348,P0.05)。早發(fā)型敗血癥致病菌以革蘭陰性桿菌為主[占39.58%(57/144例),其中肺炎克雷伯菌肺炎亞種21例、大腸埃希菌20例],其次為凝固酶陰性葡萄球菌47例[占32.64%(47/144例)]；晚發(fā)型敗血癥致病菌以革蘭陽性球菌為主[占58.65%(122/208例),其中凝固酶陰性葡萄球菌90例(43.27%)],其次為大腸埃希菌37例[17.79%(37/208例)。兩組轉(zhuǎn)歸比較,差異無統(tǒng)計(jì)學(xué)意義(x2=1.187,P=0.552)。結(jié)論：早發(fā)型和晚發(fā)型敗血癥在臨床、實(shí)驗(yàn)室檢查方面存在一定差異。新生兒敗血癥區(qū)分早發(fā)型和晚發(fā)型對臨床選用抗菌藥物有一定參考價(jià)值。
[Abstract]:Objective: to analyze and compare the clinical characteristics, nonspecific indexes, pathogenic bacteria distribution and drug sensitivity of early-onset neonatal septicemia (EOS) and late-onset neonatal septicemiaemia (Los) in neonates, in order to guide clinical diagnosis and treatment. Methods: 352 cases of neonatal septicemia with positive blood culture were selected and divided into early septicemia and late septicemia according to the onset time. The clinical data were retrospectively analyzed and compared. Results among 352 newborns with septicemia, 144 (40.91%) had early onset, 208 (59.09%) had late onset and 108 (51.92%) had nosocomial infection. Early septicemia occurred in full-term infants [107 / 144 cases (74.31%)], late septicemia occurred in premature infants [77 / 208 cases (37.02%)] and low birth weight infants [70 / 208 cases (33.65%)]. The proportion of neonatal asphyxia with premature septicemia [21 / 144 (14.58%)], intrauterine distress [14 / 144 (9.72%)], feces staining of amniotic fluid [26 / 144 (18.06%)], premature rupture of membranes 鈮

本文編號：2080121