CAJ | 학술논문

目的：分析新生儿重症监护室（NICU）发生的导管相关性异常汉逊酵母菌败血症的临床特征、防控措施、治疗预后。方法回顾性分析2013年9—10月在深圳市人民医院 NICU 发生的导管相关性异常汉逊酵母菌败血症5例患儿的临床资料，记录其临床表现、实验室和影像学检查结果，并进行药敏试验和菌株鉴定。结果5例患儿均为极低出生体质量儿，均有外周中心静脉置管（PICC）2周以上经历，部分有肠外营养。5例患儿均出现发热，3例心率增快，1例反应欠佳，3例出现发绀、呼吸暂停，3例有气促表现。2例患儿出现白细胞计数减少，1例出现血小板减少，1例 C 反应蛋白（CRP）增高，1例肺部出现新病灶。5例脑脊液检查正常。该菌对氟康唑敏感。患儿均及时拔除导管，采用氟康唑静脉滴注，12 mg·kg -1·d -1，治疗均痊愈。随访1年，5例患儿生长发育未见明显异常。NICU 经过强化健康教育和管理，加强手卫生等措施，未再出现院内侵入性真菌感染。结论导管相关性异常汉逊酵母菌败血症病例罕见，临床特点与常见真菌败血症相似，该病可防可控，氟康唑治疗效果满意，预后好。
목적：분석신생인중증감호실（NICU）발생적도관상관성이상한손효모균패혈증적림상특정、방공조시、치료예후。방법회고성분석2013년9—10월재심수시인민의원 NICU 발생적도관상관성이상한손효모균패혈증5례환인적림상자료，기록기림상표현、실험실화영상학검사결과，병진행약민시험화균주감정。결과5례환인균위겁저출생체질량인，균유외주중심정맥치관（PICC）2주이상경력，부분유장외영양。5례환인균출현발열，3례심솔증쾌，1례반응흠가，3례출현발감、호흡잠정，3례유기촉표현。2례환인출현백세포계수감소，1례출현혈소판감소，1례 C 반응단백（CRP）증고，1례폐부출현신병조。5례뇌척액검사정상。해균대불강서민감。환인균급시발제도관，채용불강서정맥적주，12 mg·kg -1·d -1，치료균전유。수방1년，5례환인생장발육미견명현이상。NICU 경과강화건강교육화관리，가강수위생등조시，미재출현원내침입성진균감염。결론도관상관성이상한손효모균패혈증병례한견，림상특점여상견진균패혈증상사，해병가방가공，불강서치료효과만의，예후호。
Objective To analyze the clinical features,prevention and control measures,treatment and prognosis of catheter - related hansenula anomala fungemia occurring in neonatal intensive care unit( NICU). Methods We made a retrospective analysis of the clinical data of 5 neonates with catheter - related hansenula anomala fungemia occuring in NICU of Shenzhen People' s Hospital from September to October in 2013. Clinical manifestation,laboratory examination results and imageological examination results were recorded,and drug sensitivity test and strain identification were conducted. Results The 5 newborns were all very low birth weight infant and were all administrated with PICC for more than 2 weeks,and partial parenteral nutrition was given to several of the newborns. The 5 newborns all had fever,3 had accelerated heart rate,1 had poor response,3 had cyanosis and apnea,and 3 had shortness of breath. Leukopenia occurred in 2 newborns,thrombocytopenia occurred in 1 newborn,elevation of CRP occurred in 1 newborn,new nidus in lung was found in one newborn. The 5 newborns all had normal results of cerebrospinal fluid examination. The fungus showed sensitivity to fluconazole. The catheters were timely removed in all the 5 cases,and intravenous drip of fluconazole was administrated by 12 mg·kg - 1 ·d - 1 ,after which all the 5 newborns were cured. During the one - year follow - up,obvious abnormality was not noted in the 5 newborns. By improving health education,health management and hand hygiene,nosocomial fungal invasive infection on longer occurred in the NICU. Conclusion Catheter - related hansenula anomala fungemia is rare and has similar clinical features with common fungemia. The disease could be prevented and controlled,and fluconazole has good therapeutic effect and prognosis.