目的 探讨新生儿早发型脓毒症(EOS)的临床特点及死亡相关因素.方法 选取广西壮族自治区妇幼保健院2000年1月至2013年6月收治的EOS引起7日龄内死亡的病例作为死亡组;同期纳入的当月发生EOS未死亡的患儿设为存活组,设计统计表格,检索病历资料.结果 死亡组16例,存活组54例;死亡组与存活组母体及产科因素、新生儿一般情况比较,母亲年龄[分别为(29.8±8.2)岁,(28.2±6.0)岁]、居住环境[城市:12例(75％),40例(74％)]、受孕方式[辅助生殖:2例(12％),5例(9％)]、分娩方式[剖宫产:4例(25％),10例(19％)]、先兆子(间)[2例(13％),16例(30％)]、母亲糖尿病[2例(13％),5例(9％)]、宫内窘迫[6例(38％),23例(43％)]、胎膜早破[4例(25％),16例(30％)]、宫内感染[14例(88％),37例(69％)]、绒毛膜羊膜炎[10例(63％),33例(61％)]、胎盘功能不全[6例(38％),16例(30％)]、胎龄[(36.8±1.7)周,(37.5±1.6)周]、出生体质量[(2 695.9±688.6)g,(2 895.8±466.8)g]、宫内发育迟滞[3例(19％),7例(13％)]、窒息[7例(13％),6例(1 1％)]差异均无统计学意义(P均＞0.05),母亲感染性发热[7例(44％),4例(7％)]差异有统计学意义(P =0.002);新生儿并发症:动脉导管未闭[5例(31％),7例(13％)]2组差异无统计学意义(P＞0.05),坏死性小肠结肠炎(NEC)[10例(63％),17例(32％)]、急性肺损伤(ALI)[8例(50％),11例(20％)]、肺出血[6例(38％),3例(6％)]、弥散性血管内凝血(DIC)[9例(56％),11例(20％)]差异均有统计学意义(P=0.025,0.043,0.003,0.013);病原菌检出情况:大肠埃希菌[10例(63％),34例(63％)]、大肠杆菌[7例(44％),19例(35％)]、肺炎克雷伯菌[8例(50％),24例(44％)]、铜绿假单胞菌[6例(38％),15例(28％)]、金黄色葡萄球菌[4例(25％),9例(18％)]、表皮葡萄球菌[5例(31％),9例(17％)]、人葡萄球菌[3例(19％),3例(6％)]、其他凝固酶阴性葡萄球菌(CNS)[5例(31％),12例(22％)]、链球菌[4例(25％),8例(15％)]、白色念珠菌[2例(13％),5例(9％)]、其他真菌[2例(13％),8例(15％)]差异均无统计学意义(P均＞0.05).进行Logistic回归分析,母亲发热、NEC、肺出血、DIC差异均有统计学意义(P=0.030,0.021,0.024,0.033).结论 母亲产前感染性发热是致死性EOS发生的显著因素,NEC、ALI、肺出血、DIC是EOS病情发展难以逆转的危险因素,致死性EOS的致病菌与存活组相比无特异性.
目的 探討新生兒早髮型膿毒癥(EOS)的臨床特點及死亡相關因素.方法 選取廣西壯族自治區婦幼保健院2000年1月至2013年6月收治的EOS引起7日齡內死亡的病例作為死亡組;同期納入的噹月髮生EOS未死亡的患兒設為存活組,設計統計錶格,檢索病歷資料.結果 死亡組16例,存活組54例;死亡組與存活組母體及產科因素、新生兒一般情況比較,母親年齡[分彆為(29.8±8.2)歲,(28.2±6.0)歲]、居住環境[城市:12例(75％),40例(74％)]、受孕方式[輔助生殖:2例(12％),5例(9％)]、分娩方式[剖宮產:4例(25％),10例(19％)]、先兆子(間)[2例(13％),16例(30％)]、母親糖尿病[2例(13％),5例(9％)]、宮內窘迫[6例(38％),23例(43％)]、胎膜早破[4例(25％),16例(30％)]、宮內感染[14例(88％),37例(69％)]、絨毛膜羊膜炎[10例(63％),33例(61％)]、胎盤功能不全[6例(38％),16例(30％)]、胎齡[(36.8±1.7)週,(37.5±1.6)週]、齣生體質量[(2 695.9±688.6)g,(2 895.8±466.8)g]、宮內髮育遲滯[3例(19％),7例(13％)]、窒息[7例(13％),6例(1 1％)]差異均無統計學意義(P均＞0.05),母親感染性髮熱[7例(44％),4例(7％)]差異有統計學意義(P =0.002);新生兒併髮癥:動脈導管未閉[5例(31％),7例(13％)]2組差異無統計學意義(P＞0.05),壞死性小腸結腸炎(NEC)[10例(63％),17例(32％)]、急性肺損傷(ALI)[8例(50％),11例(20％)]、肺齣血[6例(38％),3例(6％)]、瀰散性血管內凝血(DIC)[9例(56％),11例(20％)]差異均有統計學意義(P=0.025,0.043,0.003,0.013);病原菌檢齣情況:大腸埃希菌[10例(63％),34例(63％)]、大腸桿菌[7例(44％),19例(35％)]、肺炎剋雷伯菌[8例(50％),24例(44％)]、銅綠假單胞菌[6例(38％),15例(28％)]、金黃色葡萄毬菌[4例(25％),9例(18％)]、錶皮葡萄毬菌[5例(31％),9例(17％)]、人葡萄毬菌[3例(19％),3例(6％)]、其他凝固酶陰性葡萄毬菌(CNS)[5例(31％),12例(22％)]、鏈毬菌[4例(25％),8例(15％)]、白色唸珠菌[2例(13％),5例(9％)]、其他真菌[2例(13％),8例(15％)]差異均無統計學意義(P均＞0.05).進行Logistic迴歸分析,母親髮熱、NEC、肺齣血、DIC差異均有統計學意義(P=0.030,0.021,0.024,0.033).結論 母親產前感染性髮熱是緻死性EOS髮生的顯著因素,NEC、ALI、肺齣血、DIC是EOS病情髮展難以逆轉的危險因素,緻死性EOS的緻病菌與存活組相比無特異性.
목적 탐토신생인조발형농독증(EOS)적림상특점급사망상관인소.방법 선취엄서장족자치구부유보건원2000년1월지2013년6월수치적EOS인기7일령내사망적병례작위사망조;동기납입적당월발생EOS미사망적환인설위존활조,설계통계표격,검색병력자료.결과 사망조16례,존활조54례;사망조여존활조모체급산과인소、신생인일반정황비교,모친년령[분별위(29.8±8.2)세,(28.2±6.0)세]、거주배경[성시:12례(75％),40례(74％)]、수잉방식[보조생식:2례(12％),5례(9％)]、분면방식[부궁산:4례(25％),10례(19％)]、선조자(간)[2례(13％),16례(30％)]、모친당뇨병[2례(13％),5례(9％)]、궁내군박[6례(38％),23례(43％)]、태막조파[4례(25％),16례(30％)]、궁내감염[14례(88％),37례(69％)]、융모막양막염[10례(63％),33례(61％)]、태반공능불전[6례(38％),16례(30％)]、태령[(36.8±1.7)주,(37.5±1.6)주]、출생체질량[(2 695.9±688.6)g,(2 895.8±466.8)g]、궁내발육지체[3례(19％),7례(13％)]、질식[7례(13％),6례(1 1％)]차이균무통계학의의(P균＞0.05),모친감염성발열[7례(44％),4례(7％)]차이유통계학의의(P =0.002);신생인병발증:동맥도관미폐[5례(31％),7례(13％)]2조차이무통계학의의(P＞0.05),배사성소장결장염(NEC)[10례(63％),17례(32％)]、급성폐손상(ALI)[8례(50％),11례(20％)]、폐출혈[6례(38％),3례(6％)]、미산성혈관내응혈(DIC)[9례(56％),11례(20％)]차이균유통계학의의(P=0.025,0.043,0.003,0.013);병원균검출정황:대장애희균[10례(63％),34례(63％)]、대장간균[7례(44％),19례(35％)]、폐염극뢰백균[8례(50％),24례(44％)]、동록가단포균[6례(38％),15례(28％)]、금황색포도구균[4례(25％),9례(18％)]、표피포도구균[5례(31％),9례(17％)]、인포도구균[3례(19％),3례(6％)]、기타응고매음성포도구균(CNS)[5례(31％),12례(22％)]、련구균[4례(25％),8례(15％)]、백색념주균[2례(13％),5례(9％)]、기타진균[2례(13％),8례(15％)]차이균무통계학의의(P균＞0.05).진행Logistic회귀분석,모친발열、NEC、폐출혈、DIC차이균유통계학의의(P=0.030,0.021,0.024,0.033).결론 모친산전감염성발열시치사성EOS발생적현저인소,NEC、ALI、폐출혈、DIC시EOS병정발전난이역전적위험인소,치사성EOS적치병균여존활조상비무특이성.
Objective To study the characteristics and risk factors of infants early onset sepsis (EOS) in infants which resulted in death.Methods Among the infants admitted to the Maternal and Child Health Hospital of Guangxi Zhuang Autonomous from Jan.2000 to Jun.2013,the EOS cases died during the first week were chosen as the mortality group,while the survival babies who were attacked with EOS admitted during the same months as the control group.Their clinical records were collected and analyzed.Results Sixteen cases of the mortality group and 54 cases of the survival group were included.The cases of maternal infection-related fever in the mortality group were more than those in the control group[7 cases(44％) in the mortality group and 4 cases(7％) in the control group],there was statistical difference(P =0.002).Furthermore,other maternal factors and delivery situations were compared between the mortality group and the survival group,such as maternal age[(29.8 ± 8.2) years old,(28.2 ±6.0) years old],city inhabitants[12 cases(75％),40 cases(74％)],assisted reproduction[2 cases(12％),5 cases(9％)],cesarean section [4 cases (25 ％),1 0 cases (19％)],preeclampsia [2 cases (13 ％),16 cases (30％)],maternal diabetes [2 cases(13％),5 cases(9％)],intrauterine distress[6 cases(38％),23 cases(43％)],premature rupture of membrane[4 cases (25 ％),16 cases (30％)],intrauterine infection [14 cases (88％),37 cases (69％)],chorioamnionitis [10 cases (63 ％),33 cases (61％)],placental dysfunction [6 cases (38％),16 cases (30％)],gestational age [(36.8 ± 1.7)weeks,(37.5 ± 1.6) weeks],birth weight[(2 695.9 ±688.6) g,(2 895.8 ±466.8) g],intrauterine growth retarded [3 cases(19％),7 cases(13％)]and neonatal asphxia[7 cases(13％),6 cases(11％)],which were not statistically different.The similar statistical finding included the following:the diagnosis of patent ductus arteriosis(PDA) [5 cases (31％),7 cases(13％)]and the result of blood nature such as escherichia coli[10 cases(63％),34 cases(63％)],E.coli[7 cases (44％),19 cases (35％)],klebsiella pneumoniae [8 cases (50％),24 cases (44％)],pseudomonas aeruginosa [6 cases (38％),15 cases (28％)],staphylococcus aureus [4 cases (25 ％),9 cases (18％)],staphylococcus epidermidis[5 cases (31％),9 cases (17％)],staphylococcus hominis [3 cases (19％),3 cases (6％)],other coagulase negative staphylococcus(CNS) [5 cases (31％),12 cases (22％)],lactococcus [4 cases (25％),8 cases (15％)],candida albicans[2 cases(13％),5 eases(9％)],other fungi [2 cases(13％),8 cases(15％)].However,the discrepancies between the mortality group and the control group on diagnosis included necrotizing enterocolitis (NEC) [10 cases (63％),17 cases(32％)],acute lung injure (ALl) [8 cases (50％),11 cases (20％)],pulmonary haemorrhage[6 cases(38％),3 cases(6％)],disseminated intravascular coagulation(DIC) [9 cases(56％),11 cases (20％)],which had statistical significance(respectively,P =0.025,0.043,0.003,0.013).According to Logistic regression,maternal fever,NEC,pulmonary hemorrhage,DIC were the relative risk factors in statistics (P =0.030,0.021,0.024,0.033).Conclusions Acute maternal infection-related fever is likely to be the risk factors for nortality in the infants attacked with EOS,and no differentiation between the 2 groups was found in respect with pathogen.Furthermore,complicated with NEC,ALI,pulmonary haemorrhage and DIC are the irreversible risk factors for babies with EOS.
