临床儿科杂志
臨床兒科雜誌
림상인과잡지
2014年
9期
816-820
,共5页
真菌败血症%两性霉素%血小板计数%新生儿
真菌敗血癥%兩性黴素%血小闆計數%新生兒
진균패혈증%량성매소%혈소판계수%신생인
fungal septicemia%amphotericin%platelet counts%neonate
目的：探讨新生儿真菌性败血症的高危因素、病原谱、药物敏感性以及抗菌药物治疗效果。方法回顾性分析2009年5月至2013年8月收治的新生儿真菌性败血症患者的临床资料。结果共收治23例新生儿真菌性败血症，培养出真菌36株，其中近平滑假丝酵母菌20株(55.6%)、白色假丝酵母菌11株(30.6%)。药敏试验显示，真菌对两性霉素、五氟尿嘧啶敏感性最高，总有效率在69.4%~77.8%。23例新生儿均有早产、低出生体质量、应用广谱抗生素、有创操作等真菌性败血症的高危因素。抗真菌治疗后预后良好(存活或好转出院)15例(65.2%)，预后不良(放弃或死亡)8例(34.8%)。预后良好组的平均抗真菌治疗时间高于预后不良组，差异有统计学意义(t=2.982，P<0.05)。抗真菌治疗前及治疗后2周内，新生儿的肝肾功能及外周血白细胞变化不明显；血小板在抗真菌治疗开始后1周内即升高，与治疗前差异有统计学意义(P<0.05)。结论新生儿真菌败血症病原菌以假丝酵母菌为主，对两性霉素敏感性较高；足疗程抗真菌治疗可提高治愈率。
目的：探討新生兒真菌性敗血癥的高危因素、病原譜、藥物敏感性以及抗菌藥物治療效果。方法迴顧性分析2009年5月至2013年8月收治的新生兒真菌性敗血癥患者的臨床資料。結果共收治23例新生兒真菌性敗血癥，培養齣真菌36株，其中近平滑假絲酵母菌20株(55.6%)、白色假絲酵母菌11株(30.6%)。藥敏試驗顯示，真菌對兩性黴素、五氟尿嘧啶敏感性最高，總有效率在69.4%~77.8%。23例新生兒均有早產、低齣生體質量、應用廣譜抗生素、有創操作等真菌性敗血癥的高危因素。抗真菌治療後預後良好(存活或好轉齣院)15例(65.2%)，預後不良(放棄或死亡)8例(34.8%)。預後良好組的平均抗真菌治療時間高于預後不良組，差異有統計學意義(t=2.982，P<0.05)。抗真菌治療前及治療後2週內，新生兒的肝腎功能及外週血白細胞變化不明顯；血小闆在抗真菌治療開始後1週內即升高，與治療前差異有統計學意義(P<0.05)。結論新生兒真菌敗血癥病原菌以假絲酵母菌為主，對兩性黴素敏感性較高；足療程抗真菌治療可提高治愈率。
목적：탐토신생인진균성패혈증적고위인소、병원보、약물민감성이급항균약물치료효과。방법회고성분석2009년5월지2013년8월수치적신생인진균성패혈증환자적림상자료。결과공수치23례신생인진균성패혈증，배양출진균36주，기중근평활가사효모균20주(55.6%)、백색가사효모균11주(30.6%)。약민시험현시，진균대량성매소、오불뇨밀정민감성최고，총유효솔재69.4%~77.8%。23례신생인균유조산、저출생체질량、응용엄보항생소、유창조작등진균성패혈증적고위인소。항진균치료후예후량호(존활혹호전출원)15례(65.2%)，예후불량(방기혹사망)8례(34.8%)。예후량호조적평균항진균치료시간고우예후불량조，차이유통계학의의(t=2.982，P<0.05)。항진균치료전급치료후2주내，신생인적간신공능급외주혈백세포변화불명현；혈소판재항진균치료개시후1주내즉승고，여치료전차이유통계학의의(P<0.05)。결론신생인진균패혈증병원균이가사효모균위주，대량성매소민감성교고；족료정항진균치료가제고치유솔。
Objective To investigate the risk factors, pathogens spectrum and antimicrobial susceptibility of neonatal fungal septicemia. Methods Medical records of 23 neonates with fungal septicemia from May 2009 to August 2013 were analyzed retrospectively. Results A total of 36 strains of fungi including 20 strains of Candidaparapsilosis (55.6%) and 11 strains of Candidaalbicans (30.6%) were isolated from 23 patients. Fungal pathogens were susceptible to amphotericin and lfuorouracil, with susceptibility being 69.4%-77.8%. Prematurity, low birth weight, application of broad-spectrum antibiotics and invasive operation might be the risk factors of fungal septicemia. Fifteen cases (65.2%) had good outcomes (survival or partial restoration), while 8 cases (34.8%) had poor outcomes (withdrawing therapy or death). The duration of antifungal therapy in good prognosis group was longer than that in poor prognosis group (t=2.982, P<0.05). No significant difference in indicators of liver and kidney function was observed between before antifungal therapy and within 2 weeks after treatment. Meanwhile, no signiifcant difference of WBC was found between before antifungal therapy and within 2 weeks after treatment. The platelet counts were increased within one week after initial antifungal therapy (P<0.05). Conclusions Candida is the main pathogen of neonatal fungal septicemia and sensitive to amphotericin B. Long enough course of antifungal therapy is necessary to improve the cure rate.
