C反应蛋白在新生儿败血症中的诊断价值研究

目的研究C反应蛋白(CRP)在新生儿败血症诊断中的诊断价值。方法选取60例被确诊为败血症的新生儿设为观察组,同时选取60例健康新生儿设为对照组。测定血清CRP水平并同时检测白细胞(WBC)计数,进行血培养,对血培养阳性的患儿进行药敏实验。比较CRP、WBC、CRP+WBC的诊断价值。结果观察组中,血培养阳性54例,CRP阳性49例,WBC阳性38例。CRP+WBC检测新生儿败血症的准确率明显高于CRP和WBC单独检测(P0.05)。CRP+WBC联合检测的ROC曲线下面积为0.852 1,高于CRP和WBC。结论 CRP联合WBC检测对于诊断新生儿败血症具有一定的临床应用价值。     

The impact of oral glutamine supplementation on the intestinal permeability and incidence of necrotizing enterocolitis/septicemia in premature neonates

Objective.?To examine the impact of oral glutamine (Gln) supplementation on gut integrity and on the incidence of necrotizing enterocolitis (NEC)/septicemia of premature neonates.

Methods.?Preterm neonates (n?=?101, gestational age?<34 weeks, birth weight?<2000?g) were randomly allocated to receive from day 3 to day 30 postpartum, either oral Gln (0.3 g/kg/day, n?=?51-Gln group) or placebo (caloreen-isocaloric, n?=?50-control group). Intestinal permeability was determined from the urinary lactulose/mannitol recovery (L/M ratio) following their oral administration and assessed at three time points: day 2 (before first administration), day 7 and day 30 of life. The incidence of NEC and septicemia over the study period was also recorded.

Results.?A decrease of lactulose recovery at days 7 (p?=?0.001) and 30 (p?<?0.001) and a decrease of L/M ratio at day 7 (p?=?0.002) were observed only in the Gln group. Lactulose recovery and L/M ratio at day 7 (p?=?0.022 and p?=?0.004, respectively), as well as lactulose recovery (p?=?0.001), mannitol recovery (p?=?0.042), and L/M ratio (p?=?0.001) at day 30, were decreased in the Gln group as compared to controls. NEC and septicemia were lower in the Gln group at the end of the first week (p?=?0.009 and p?=?0.041, respectively) and up to the end of the study (p?<?0.001 and p?=?0.048, respectively).

Conclusion.?Oral Gln administration may have beneficial effects on intestinal integrity and the overall incidence of NEC/septicemia in preterm infants.     

新生儿B族链球菌败血症15例的临床分析

目的 探讨新生儿B族链球菌(GBS)败血症的临床特点.方法 选择2012年1月至2015年12月在广东省佛山市南海区人民医院接受治疗的血培养阳性的GBS败血症新生儿15例,分析其临床特点.结果 15例GBS败血症患儿中早发型GBS败血症患儿10例,晚发型GBS败血症患儿5例,早发型GBS败血症患儿以呼吸系统症状为主,出生24h内发病,晚发型GBS败血症患儿以高热为首发症状,均合并化脓性脑膜炎.GBS败血症患儿的白细胞水平较低,降钙素原反应灵敏,C反应蛋白反应相对滞后.GBS菌株对青霉素和万古霉素高度敏感,敏感性均为100%,其次为头孢呋辛(93.33%).结论 新生儿GBS败血症起病凶险,可造成永久神经系统损伤,医院开展产前GBS筛查对减少新生儿GBS感染有较大的意义,对于存在白细胞下降、PCT异常,且存在呼吸系统症状的新生儿,应尽早给予治疗.     

血清白蛋白在判断新生儿败血症预后中的临床意义

目的:探讨血清白蛋白(ALB)水平对新生儿败血症患儿预后的影响。方法:将92 例新生儿败血症患儿根据预后情况分为 存活组(62 例)和死亡组(30 例)。在确诊为新生儿败血症时及确诊后的第1、3、5、7天检测两组血清ALB。于确诊为新生儿败血 症时比较两组血清降钙素原(PCT)水平、超敏C 反应蛋白(hs-CRP)水平、白细胞(WBC)计数、血小板(PLT)计数和新生儿危重病 例评分(NCIS);应用Pearson 相关性分析血清ALB 水平与PCT水平、hs-CRP水平、WBC 计数、PLT计数和NCIS的相关性。新生儿 败血症确诊时绘制92 例患儿血清ALB 水平的受试者工作特征(ROC)曲线,分析其对死亡的预测效果。结果:死亡组血清ALB 在 确诊新生儿败血症时及确诊后的第1、3、5、7天一直维持较低水平,存活组血清ALB上升,且死亡组均低于存活组(P<0.05);确诊 为新生儿败血症时,死亡组血清PCT水平、hs-CRP水平和WBC计数高于存活组,PLT计数和NCIS低于对照组(P<0.05);经过 Pearson相关分析,血清ALB水平与PCT水平、hs-CRP水平和WBC计数呈负相关,与PLT计数、NCIS呈正相关(P<0.05);92例新 生儿败血症患儿血清ALB水平对死亡预测的ROC曲线下总面积为0.878,21.17 g/L为血清ALB的最佳阈值,灵敏度为87.63%, 特异性为100%。结论:血清ALB水平可作为新生儿败血症预后判断指标,为后期临床治疗提供依据。     

Shewanella infection in decompensated liver disease: a septic case

Shewanella species are an unusual cause of disease in humans. However, reports of Shewanella infections have been increasing, and hepatobiliary disease has been proposed as a predisposing factor following a critical course. We report the first Japanese septic case of decompensated liver disease in which this bacterium acted as a definite pathogen. A 67-year-old Japanese man with primary sclerosing cholangitis was admitted to our hospital complaining of fever, general fatigue, pain, and a rash on the lower left extremity. He was tentatively diagnosed with necrotizing fasciitis caused by Vibrio vulnificus because of his decompensated cirrhotic liver and history of consuming raw fish. Thereafter, the diagnosis was altered to cellulitis and Shewanella septicemia on the basis of the characteristics of his skin lesion and an arterial blood culture. He died of multiple organ failure on the eleventh day in the hospital. Since several reports have demonstrated that Shewanella can cause lethal sepsis in patients with hepatobiliary disease, we should be aware of the pathogenicity of this bacterium.     

败血症及其死亡病例病因分析

目的探讨败血症及因其死亡患者的临床和细菌学特征。方法回顾性分析某院6年来临床确诊治疗的240例败血症及因其死亡的29例患者的临床和实验室资料。结果240例败血症患者血培养共分离感染菌62种,凝固酶阴性葡萄球菌（CNS）居所有病原菌首位,占27．92％;29例病死患者中,革兰阴性（G^-）杆菌（大肠埃希菌占41．38％）败血症最多,占65．52％,其次是CNS,占20．69％。死亡病例中,男性多于女性（Χ^2=5．29,P〈0．05）,≥15岁者多于％15岁者（Χ^2=5．59,P〈0．05）,医院感染者多于社区感染者（Χ^2=43．94,P〈0．01）。结论CNS为败血症的首要病原菌,但以大肠埃希菌为主的G杆菌仍是导致败血症患者死亡的主要病原菌。败血症死亡者中,以成人、男性、医院感染者居多。     

凝固酶阴性葡萄球菌致新生儿败血症的耐药性分析

目的探讨凝固酶阴性葡萄球菌(CNS)致新生儿败血症的病原学及耐药性现状,为临床诊断与治疗提供实验室依据。方法对139例CNS致新生儿败血症血培养的病原学及耐药性进行回顾性分析。结果 218份血培养细菌阳性标本中,共分离出CNS 139株,占63.8%;耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)70株,检出率为50.4%,MRCNS多药耐药现象严重,对磺胺甲噁唑/甲氧苄啶的耐药率高达92.9%,对环丙沙星、庆大霉素、克林霉素的耐药率在57.1%~68.6%,与MSCNS相比差异有统计学意义(P<0.01);MRCNS与MSCNS对红霉素和青霉素的耐药率均>80.0%,MRCNS对米诺环素的耐药率较低,为4.3%,未见耐万古霉素菌株。结论 CNS已成为新生儿血液感染第1位的病原菌,检出率高且呈多药耐药;万古霉素仍是MRCNS的最佳药物;临床应根据血培养和药敏结果选用敏感抗菌药物,以减少耐药菌株产生,提高治疗效果。     

ICU患者血浆内毒素定量检测在革兰阴性菌败血症早期诊断中的应用

目的研究血浆中内毒素定量检测在革兰阴性菌败血症早期诊断中的临床应用价值。方法采集医院疑似革兰阴性菌败血症的112例重症监护病房患者静脉血标本,同时进行血浆内毒素定量检测和血培养检测,比较两种检测方法的差异。结果革兰阴性菌败血症患者组血浆内毒素含量为(109.6±112.1)pg/mL,明显高于非败血症组的(6.5±5.9)pg/mL,差异有统计学意义(P<0.01)。以20pg/mL为临界值时,血浆内毒素含量检测阳性49例(43.7%),阴性63例(56.3%);血培养阳性24例(21.4%),阴性88例(78.6%)。血浆内毒素检测具有较好的敏感度(85.7%)和特异度(90.3%),阳性预测值(87.6%)和阴性预测值(92.3%)均较高;血培养的敏感度较低(46.2%),但特异度较高(92.4%),阳性预测值和阴性预测值分别为86.5%和80.7%。两种方法联合检测后敏感度提高至95.2%,特异度为88.9%。结论血浆内毒素定量测定具有快速、敏感的特点,对革兰阴性菌败血症的早期诊断具有一定的临床应用价值。     

新生儿枯草杆菌败血症(附18例临床分析)

本文报告我院儿科1984～1987年收治18例新生儿枯草杆菌败血症,治愈率78%,死亡率11%。该病之临床表现不典型,细菌对多种抗生素耐药。讨论了枯草杆菌败血症的临床有关问题。提出应在临床诊断中提高对本病的认识,强调选择效抗生素治疗的同时,加强支持疗法的重要性。     

脑脊液溶菌酶测定对中枢神经系统疾病的诊断价值

对部分病毒性脑膜炎(病毒脑)、化脓性脑膜炎(化脑)、结核性脑膜炎(结脑)、脑血栓形成等神经系统疾病患者进行了脑脊液(CSF)溶菌酶测定。结果表明:细菌性与非细菌性脑膜炎有显著性差别(P<0.01),对于结脑和化脑,由于病程不同,也有一定的鉴别价值。而脑血栓形成和脑出血患者,脑脊液溶菌酶含量与对照组比较无显著性差别(P>0.05)。新生儿败血症与新生儿败血症并发化脑患者之间,脑脊液溶菌酶含量有显著性差别(P<0.05)。因此脑脊液溶菌酶测定对上述疾病的诊断及鉴别诊断有较高价值。