临床儿科杂志 ›› 2019, Vol. 37 ›› Issue (1): 1-5.doi: 10.3969/j.issn.1000-3606.2019.01.001

• 新生儿疾病专栏 •    下一篇

极早早产儿早发型败血症低风险人群临床特征分析

花媛媛,苗静琨,邹仙,等   

  1. 重庆医科大学附属儿童医院新生儿诊治中心 国家住院医师规范化培训示范基地 儿童发育疾病研究 教育部重点实验室 儿童发育重大疾病国家国际科技合作基地 儿科学重庆市重点实验室 (重庆 400014)
  • 出版日期:2019-01-15 发布日期:2019-01-31
  • 通讯作者: 陈启雄 电子信箱:chengqixiong@126.com

Clinical characteristics of extremely premature infants at low risk for early-onset sepsis

HUA Yuanyuan, MIAO Jingkun, ZOU Xian, et al   

  1. Department of Newborn, Children’s Hospital of Chongqing Medical University; National Demonstration Base of Standardized Training Base for Resident Physicians, Ministry of Education Key Laboratory of Child Development and Disorders; China International Science and Technology Corporation Base of Child Development and Critical Disorders; Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
  • Online:2019-01-15 Published:2019-01-31

摘要: 目的 探讨分析极早早产儿中早发型败血症低风险发病人群的临床特征,以避免抗生素的过度使用。方法 收集2010年1月1日—2017年12月31日住院的极早早产儿临床资料。将无胎膜早破,同时母孕期无绒毛膜羊膜炎临床 表现的极早早产儿归入低风险组,不满足低风险条件的即为对照组。根据生后72小时内血培养结果诊断早发型败血症, 回顾分析两组极早早产儿的临床特点、治疗及结局。结果 共纳入245例极早早产儿,其中低风险组153例(62.4%)。 与对照组相比,低风险组母亲妊娠期糖尿病和高血压比例较高,产前激素使用率较高,产前抗生素使用率较低,新生儿 Apgar评分<5分比例较低,肺表面活性物质使用及呼吸支持和机械通气比例较高;低风险组的死亡风险和早发型败血症 发生率都降低;差异均有统计学意义(P<0.05)。 在存活时间>24小时的极早早产儿中,低风险组的呼吸窘迫综合征、动 脉导管未闭、颅内出血、支气管肺发育不良的发生率均高于对照组;肺出血的发生率低于对照组,差异均有统计学意义 (P<0.05)。 低风险患儿中,与抗生素短时组相比,抗生素长时组死亡、呼吸窘迫综合征、支气管肺发育不良的发生风险 均增加,肺出血发生风险降低。结论 早期识别极早早产儿中早发型败血症低风险人群,对减少早期经验性抗生素治疗 有临床指导意义。

关键词: 早发败血症; 危险因素; 临床特征; 抗生素; 极早早产儿

Abstract: Objective To explore and analyze the clinical characteristics of extremely premature infants at low risk for early-onset sepsis (EOS), so as to avoid overuse of antibiotics. Method The clinical data of extremely premature infants hospitalized from January 1, 2010 to December 31, 2017 were collected. Extremely premature infants born from mothers without premature rupture of membranes and without maternal clinical manifestations of chorioamnionitis during pregnancy were classified assigned into the low-risk group, and those who did not meet the low-risk conditions were regarded assigned intoas the control group. EOS was diagnosed according to the results of blood culture within 72 hours after birth. The clinical characteristics, treatment and outcome of extremely premature infants between the two groups were retrospectively analyzed. Results A total of 245 extremely preterm infants were enrolled, including 153 (62.4%) in low-risk group. Compared with the control group, mothers in low-risk group had higher rates of gestational diabetes and hypertension, higher rates of antenatal hormone use and lower rates of antenatal antibiotics use; furthermore, neonates in low-risk group had lower rates of Apgar score < 5, higher rates of pulmonary surfactant use, respiratory support and mechanical ventilation, and lower risk of death and incidence of early-onset sepsis. The differences were statistically significant (P<0.05). Among In extremely premature infants whose having survival time > 24 hours, compared with control group, infants in low-risk group had higher incidences of respiratory distress syndrome, patent ductus arteriosus, intracranial hemorrhage and bronchopulmonary dysplasia, and lower incidence of pulmonary hemorrhage than control group, and the differences were statistically significant (all P<0.05). In low-risk group, the risks of death, distress syndrome, pulmonary hemorrhage and bronchopulmonary hemorrhage in long-term antibiotic group were higher than the short-term antibiotic group. Conclusion Early identification of extremely preterm infants at low risk of early-onset sepsis in extremely preterm infants is of clinical significance in reducing early empirical use of antibiotics therapy. respiratory

Key words: early-onset sepsis; risk factor; clinical characteristic; antibiotic; extremely premature infant