新生兒敗血症和疑似敗血症的臨床觀察

Clinical Observation of Neonatal Sepsis and Probable Sepsis

陳武元(Wu-Yuan Chen) ； 黃高彬(Kao-Pin Hwang) ； 呂志忠(Chu-Chong Lu) ； 黃德揚(The-Yang Huang)

《Acta Paediatrica Sinica》 26卷1期 (1985/02) Pp. 86-93

摘要

民國70年1月至民國71年12月間住院於高雄醫學院小兒科的新生兒患者，經一系列的分析後有35例診斷為敗血症，32例診斷為疑似敗血症(probable sepsis)。發病的季節以6月份到10月份最多，共有43例(64%)。發病年齡有11例(16%)在2天以下，36例(54%)在3天至14天之間。男性患兒較多，男女比例是1.8:1。重要的臨床徵候有厭食(69%)，發燒或低體溫(67%)，嗜睡(46%)，呼吸困難(43%)，腹脹(34%),　黃疸(33%)，出血傾向(33%)，和腹瀉(31%)等。入院前曾經在其他醫院住院治療者有23例(34%), 其他可循誘因分別是早產10例(15%)，新生兒期經急救處理者9例(13%)，先天異常4例(6%)，以及母親產前有感染徵候3例(4%)。具有高死亡率的因素依其亡率由高至低是血液酸鹼度低於6.90(67%), 纖維素分解物質(fibrin split product)陽性(64%)，發病年齡小於48小時(64%)，和低血壓(63%)。由35例新生兒敗血症患兒血液中共分離出42株細菌，其中革蘭氏陽性菌9株，革蘭氏陰性陽內菌有27株，綠膿桿菌有5株，厭氧菌有1株。鏈球菌只出現3株糞鏈球菌，而沒有B羣溶血性鏈球菌的陽性培養報告。抗生素敏感試驗的結果，對革蘭氏陰性菌最有效的是cefotaxime (12/13, 92%), colimycin (27/31, 87%), mikacin(16/23, 70%)和gentamicin (20/32, 63%)。對革蘭氏陽性菌最有效的是cephaloridine (8/9, 89%), sulbenicillin (6/7, 86%)，和cefotaxime (3/5, 60%)。根據各項資料的分析，我們的結論是：血液培養呈陰性的可能性敗血症之發生率表死亡率都相當高，治療上不能單以培養結果做指標。培養陽性患兒的致病菌以革蘭氏陰性腸內菌最多，雖然感染原的咸行率和醫療環境的污染尚無正確評估，醫院內感染的防止在降低罹病率上應該是當務之急。敗血性休克的臨床症狀相當常見。針對這種現象，治療上除了正確的選譯抗生素外，隨時警覺休克的徵候和及時給予適當的治療是降低死亡率的必要條件。

並列摘要

Clinical observations were made in this study of 35 cases of neonatal sepsis and 32 cases of probable sepsis. Age, seasonal distribution, prominent symptoms and signs, isolated bacterial strains and antibiotic sensitivities, infectious foci, predisposing factors and risk factors were analyzed. The 67 cases, collected from January 1981 to December 1982 in the pediatric ward of Kaohsiung Medical College Hospital, included 43 cases (64%) who were admitted from June to October. Peak age prevalence was below seven days old (29 cases or 43%). Important clinical manifestations in the order of decreasing incidence were: poor feeding (69%), hyperthermia or hypothermia (67%), lethargy (46%), dyspnea (43%), abdominal distension (34%), bleeding tendency (33%) and jaundice (33%). Prominent foci which were found along with sepsis were: enteritis (8 cases), meningitis (7 cases), and pneumonia (4 cases). Twenty-three cases, at first admitted to other hospitals, were subsequently transferred. Other predisposing factors were prematurity (15%), perinatal resuscitation (13%), congenital anomaly (6%), and signs of maternal infection during the last gestational month (4%). A total of 42 strains of organisms were isolated from the blood cultures in the 35 sepsis cases. Salmonella sp. (7 strains), Klebsiella sp. (7 strains), and E. coli (6 strains) were the most common gram negative pathogens. With the exception of three strains of Streptococcus fecalis, there was no isolate of Streptococcus. Antibiotic sensitivity tests showed that the most effective drugs for Gram negative bacteria were Cefotaxime (12/13, 92%), Colimycin (27/31, 87%), Amikacin (16/23, 70%) and Gentamicin (20/32, 63%). Those for Gram positive bacteria were Cephaloridine (8/9, 89%), Sulbenicillin (6/7, 86%), and Cefotaxime (3/5, 60%). Factors related to mortality were: blood pH＜6.90 (67%), age less than 2 days (64%), positive FSP (64%), hypotension (63%), absolute band/neutrophil ratio ≥0.20 (56%), and perinatal resuscitation (56%). In view of the high mortality rate observed in probable sepsis in neonates, and of the high prevalence of Grain negative sepsis, it is concluded that the results of blood culture could not serve as a definite guide in treating neonatal disseminating infection. Methods to decrease the mortality and morbidity in these cases are improvement of environment, careful evaluation in the presence of septic shock, and better intensive care.

並列關鍵字

newborn ； sepsis ； probable sepsis