新生儿早发型与晚发型败血症临床特征分析

目的分析比较新生儿早发型与晚发型败血症的感染途径、高危因素、临床特点及病原菌分布情况，指导临床早期诊断、治疗与干预。方法根据发病时间对我院2006年1月至2011年12月收治的88例新生儿败血症患儿进行分组，分为早发型组与晚发型组，并进行对照分析。结果在感染途径方面，两组患儿均以呼吸道感染多见（44．7％与46．O％），两组比较差异无统计学意义（P=0．906）。两组间出生情况相比较，早产、出生体质量低、羊水污染、窒息均是新生儿败血症早期发病的高危因素。两组患儿临床特点相比较，早期发病者多以吃奶差（57．9％，22／38）入院，而晚期发病者易出现发热（42．0％，21／50）。血培养阳性4l例，阳性率46．6％（41／88），两组血培养阳性标本中均以革兰阳性菌为主，分别是75．0％（15／20）、90．4％（19／21），而金黄色葡萄球菌及凝固酶阴性葡萄球菌是主要致病菌。结论早产、出生体质量低、羊水污染、窒息均是新生儿败血症早期发病的高危因素。早发型败血症常常表现为吃奶差，而晚发型败血症患儿易出现发热。早发型及晚发型败血症的常见致病菌均为革兰阳性菌，以金黄色葡萄球菌及凝固酶阴性葡萄球菌多见。针对有高危因素的患儿，应结合其临床特点早期行病原学检查，进一步明确诊断，指导临床合理用药。

Comparing and analysis of the early-onset and late-onset neonatal sepsis

Objective To analyse the pathway of infection, risk factors, clinical characteristics and pathogenic bacteria distribution of neonatal sepsis. Methods Eighty-eight neonatal with sepsis were enrooled from January 2006 to December 2011 in the First Affiliated Hospital of Lanzhou University. According to disease stage, they were divided into early-onset sepsis group and late-onset sepsis groups. Results Respiratory infections in two groups was the majority （ 44. 7% vs. 46. 0% ）, and there was no significant difference （ P = 0. 906）. That premature birth,low birth weight infant, amniotic fluid pollution and asphyxia were risk factors for early-onset sepsis. The most common clinical characteristics in early-onset sepsis were eating less milk （57. 9%, 22/38） and had fever of the late-onset sepsis （42. 0% ,21/50）. Forty-one cases were with positive blood culture and the rate was 46. 6% （41/88） ,the blood culture specimens were mainly Gram-positive bacteria in two group （75.0% （15/20）,90.4% （19/21））. The most common pathogenic bacteria were Staphylococcus anreus and Coagulase-negative staphylococci. Conclusion Premature birth, low birth weight, meconium, asphyxia are risk factors of early onset neonatal sepsis. Early-onset sepsis often shows poor feeding, and late-onset sepsis in children prone to be fever. The common pathogenic germ of early-onset and late-onset sepsis are Gram- positivebacteria,Staphylococcus aureus and coagulase-negative staphylococci common. As for neonate with high- risk factors, clinical features of early pathologic examination should be performed in order to further clarify the diagnosis and taking clinical therapy.