C反应蛋白测定在小儿败血症中的应用

目的　本研究的目的在了解C反应蛋白的 (CRP)测定对于小儿败血症的诊断价值。方法　连续选取2 0例白细胞总数不高的小儿败血症患者 ,作回顾性研究对象。比较其治疗前和治疗后 7～ 1 0d后疾病的痊愈或明显好转时CRP水平 ,并与体温、白细胞分类结果进行比较。结果　治疗后CRP水平 (0 57± 0 68μg/ml)显著低于治疗前水平 (5 90± 3 57μg/ml) ,P <0 0 0 1 ;治疗前CRP的阳性率为 1 0 0 % ,显著高于嗜中性粒细胞比率 >75 %的阳性率 (30 % )和体温高于 37 5℃的阳性率 (30 % ) ,P <0 0 0 5。结论　CRP可以作为一种反映细菌感染的敏感指标 ,有助于不典型小儿败血症的诊断和疗效观察。     

Fluconazole dosing in continuous veno-venous haemofiltration (CVVHF): need for a high daily dose of 800 mg

To cover intermediate sensitive Candida glabrata in ICU patients,fluconazole plasma peak levels at least in the range of 16–32µg/ml appear necessary for treatment. Previous studiesdid not reach these fluconazole levels under continuous veno-venoushaemofiltration (CVVHF) with dosages of 200–600 mg fluconzoledaily. In the present study, nine patients simultaneously requiringCVVHF for treatment of acute oligoanuric renal failure and antimycotictherapy of Candida septicemia received fluconazole 800 mg/day.Fluconazole plasma levels were determined to evaluate whetherthis dosage is adequate to reach the advised fluconazole levels.Patients were dialysed on two consecutive days with an ultrafiltrationrate (UF) of 1000 ml/h or 2000 ml/h, respectively, in a randomizedorder. The predilution was 800 ml/h and 1800 ml/h, respectively.The treatment was tolerated without adverse effects. All patientsreached plasma fluconazole concentrations between 16 and 32µg/ml, remaining in this range for a minimum of 1 up to24 h with a mean of 9.6 h and a UF rate of 2000 ml/h, and 15.7h with a UF rate of 1000 ml/h. So far, there are no in vivodata on the fluconazole plasma concentrations required for effectivetreatment. However, our data demonstrate, that at least thefluconazole concentrations desirable on the basis of in vitrosusceptibility testing can be reached in critically ill patientson CVVHF in an ICU setting. However, in these patients, 800mg fluconazole/day are necessary to achieve fungicidal drugconcentrations.     

Role of granulocyte colony-stimulating factor as adjunct therapy for septicemia in children with acute leukemia

The granulocyte colony-stimulating factor (G-CSF) has been shown to accelerate recovery from severe neutropenia and to decrease the incidence of documented infections after intensive chemotherapy in cancer patients. However, the routine prophylactic use of G-CSF is expensive. This study was conducted to determine the role of G-CSF as adjunct therapy for septicemia following neutropenia caused by chemotherapy in children with acute leukemia. Fifty consecutive episodes of septicemia were studied involving 34 episodes of Gram-negative, 7 episodes of Gram-positive, 5 episodes of polymicrobial bacterial septicemia, one episode of fungemia, and 3 episodes of disseminated fungal infection. In the first 25 episodes, G-CSF was not used (group A). For the next 16 episodes, G-CSF 200 μg per square meter per day subcutaneously was given immediately after the septicemia was documented until the absolute neutrophil count was maintained at more than 1,500 per cubic millimeter (group B). Thereafter, G-CSF at the same dose as that of group B was prophylactically used in all the children who received high-dose cytosine arablnc-side-containing regimens. Nine episodes of septicemia occurred (group C). The incidences of mortality per episode of septicemia in groups A, B, and C were 12.0% (3/25), 12.5% (2/16) and 0% (0/9), respectively. Statistically, there was no difference between the three groups overall and in pair-wise comparisons (all P > 0.5). The durations of G-CSF administration in group B ranged from 6 to 26 days with a median of 12 days and the durations of G-CSF administration in group C ranged from 10 to 23 days with a median of 19 days. With or without G-CSF, there may be no significant difference in the mortality of septicemia following neutropenia caused by chemotherapy in children with acute leukemia.     

Experimental study of the role of the local infectious focus in development ofPseudomonas aeruginosa septicemia

Department of Pathological Anatomy, Clinical-Biological Laboratory, and Laboratory of Immunology, Bacteriology, and Clinical Pharmacology, A. V. Vishnevskii Institute of Surgery, Academy of Medical Sciences of the USSR, Moscow. (Presented by Academician of the Academy of Medical Sciences of the USSR D. S. Sarkisov.) Translated from Byulleten' Éksperimental'noi Biologii i Meditsiny, Vol. 111, No. 3, pp. 285–287, March, 1991.     

新生儿败血症107例临床分析

目的：对新生儿败血症进行早期诊断,减少并发症,降低病死率。方法：对我院近10年来107例血培养阳性患儿的临床资料进行分析。结果：新生儿败血症临床表现无特殊性,并发症多,未梢血象、C反应蛋白均不能作为诊断依据。血培养仍是确诊的主要手段,但阳性率不高。病原菌以金黄色葡萄球菌（24．29％）为主,四联球菌（21．50％）为次,机会菌感染占50．46％。病死率以鼠伤寒沙门氏菌、大肠杆菌所致为高,分别是43．75％、33．33％。目前病原菌普遍敏感的抗生素有头孢唑啉、头孢哌酮、丁胺卡那霉素、万古霉素。结论：对拟诊病例开展L型血培养,以提高诊断率。早期应用敏感抗素控制感染,积极防治并发症,减少病死率。     

L型细菌败血症病儿的诊治

①目的　探讨小儿Ｌ型细菌败血症（ＳＢＬ）的诊断与治疗。②方法　对我院收治临床疑有败血症而普通培养无细菌生长的病儿进行高渗细菌培养,做药敏试验并用敏感抗生素进行治疗。③结果　共确定Ｌ型细菌败血症４６ 例,对其中３６ 株进行药物敏感试验。结果表明,青霉素类抗生素极不敏感,而大环内酯类、氨基甙类、先锋霉素Ｖ 等药物对Ｌ型细菌敏感性高。使用相应抗生素辅以支持疗法,治愈３９例,未愈５例,２ 例死于原发病。④结论　临床普通培养阴性而疑有败血症病儿,应做普通及高渗双份血培养以发现Ｌ型细菌,应用敏感抗生素治疗可取得满意疗效。     

免疫学测定在细菌L型败血症诊断中的意义

目的 :探讨红细胞补体受体 1(ECR1)花结率、红细胞免疫复合物 (EIC)花结率、金黄色葡萄球菌 (金葡菌 )抗体及红细胞沉降率 (ESR)测定在细菌L型败血症诊断中的意义。方法 :按郭峰改良法测定ECR1和EIC花结率 ,试管凝集法测定金葡菌抗体 ,常规法测定ESR。结果 :临床及细菌学诊断为细菌L型败血症患者组的ECR1花结率 (11.1± 7.89) %较健康对照组低 (P <0 .0 0 1) ;EIC花结率 (10 .98± 4.99) %较健康对照组高 (P <0 .0 5 ) ;金葡菌抗体 (lg 2 .4± 0 .2 )较健康对照组增高 (P <0 .0 0 1) ;ESR(33.0 9± 2 .92 )mm/ 6 0min较健康对照组快 (P <0 .0 0 1)。结论 :ECR1花结率、EIC花结率、金葡菌抗体及ESR的指标可辅助快速诊断细菌L型败血症。     

37例新生儿耐甲氧西林凝固酶阴性葡萄球菌败血症研究

目的 探讨耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)在新生儿败血症中的分布状况、耐药特征，为临床治疗提供参考。方法 按常规培养，应用WalkAway40型仪进行菌种鉴定并对13种抗菌药物进行药敏试验。结果 血培养98株细菌中分离出葡萄球菌78株，其中MRCNS37株(47．44％，37／78)，表皮葡萄球菌16株(43．24％，16／37)，溶血葡萄球菌9株(24.32％，9／37)。MRCNS对12种抗菌药物均有不同程度耐药，未发现耐万古霉素的MRCNS。结论 新生儿MRCNS败血症已属常见，临床治疗较困难，应积极采取措施预防和控制感染。     

儿童早期预警评分与新生儿危重病例评分在新生儿败血症病情评估的应用

目的探讨儿童早期预警评分(PEWS)与新生儿危重病例评分(NCIS)评估新生儿败血症(NSE)病情的价值。方法采用PEWS和NCIS评估112例NSE患儿临床资料,并对评分结果行相关性分析。结果两种评分结果存在负相关(r=-0.766,P<0.05)。107例存活患儿PEWS和NCIS中位分值为1分和102分,优于5例死亡NSE患儿的5分和84分(Z=5.25、3.77,P<0.05)。结论 PEWS和NCIS均能可靠反映NSE患儿病情。     

18例早产儿真菌败血症临床特点

目的对某院早产儿真菌败血症的临床特点进行分析,为临床诊治提供参考。方法对该院2011年1月—2013年12月18例早产儿真菌败血症的临床资料进行回顾性分析。结果 18例早产儿胎龄为27~36周,出生体重为1 050~3 100 g,其中极低出生体重儿(VLBWI)8例;均有广谱抗菌药物用药史,感染前均长时间静脉营养,10例机械通气,2例经外周静脉穿刺中心静脉置管(PICC)。临床表现以呼吸暂停、抽搐、喂养困难、反应差等为主;出现症状时间为出生后3 h~52 d。13例(72.22%)早产儿血白细胞(WBC)计数异常,12例(66.67%)血小板(PLT)100×109/L,18例(100.00%)C反应蛋白(CRP)均增高,平均CRP浓度为(41.90±26.77)mg/L。感染病原菌以假丝酵母菌属为主,共17例(94.44%),其中包括近平滑假丝酵母菌7例,白假丝酵母菌5例,白假丝酵母菌生物变种4例,无名假丝酵母菌1例。用氟康唑及两性霉素B治疗,15例治愈(83.33%),2例好转(11.11%),1例死亡(5.56%)。结论早产儿真菌败血症以假丝酵母菌感染为主,临床缺乏特异性表现,应严密观察具有高危因素的早产儿临床症状,定期检测血常规及CRP等指标,及时给予抗真菌药物治疗,有助于取得良好的治疗效果。