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目的分析早产儿白色念珠菌性败血症的临床和实验室特点,为其诊治提供参考依据。方法对2008年1月至2012年1月,沈阳市儿童医院8例NICU确诊为白色念珠菌性败血症早产儿的临床资料、辅助检查结果、治疗效果及随访资料进行回顾性分析。结果 8例念珠菌性败血症患儿均为早产儿,50%为极低出生体重儿,均合并不同原发病,4例给予呼吸机辅助通气治疗,6例置中心静脉导管(PICC),8例患儿均曾长时间静脉营养,所有病例均存在长期应用头孢三代以上广谱抗生素,临床表现为嗜睡、喂养不耐受、心动过缓、呼吸暂停、黄疸加重,甚至呼吸循环衰竭。6例白细胞异常,6例C-反应蛋白(CRP)中重度增高,血清1,3-β-D葡萄糖(BG)检测,6例呈阳性改变。8例患儿均接受氟康唑治疗,7例治愈,1例放弃治疗。结论早产儿白色念珠菌性败血症临床表现不典型、实验室检查不特异,主要与患儿胎龄、出生体重、机械通气、深静脉置管、胃肠外营养、激素和广谱抗生素的应用有关,故对有高危因素的早产儿要尽早诊断和治疗,以降低病死率。
Objective To analyze the clinical and laboratory characteristics of Candida albicans septicemia in premature infants and provide references for its diagnosis and treatment. Methods From January 2008 to January 2012, 8 cases of preterm infants diagnosed as Candida albicans septicemia in NICU of Shenyang Children’s Hospital were retrospectively analyzed. The clinical data, auxiliary examinations, therapeutic effects and follow-up data were also analyzed retrospectively. Results Eight children with Candida septicemia were premature infants and 50% with very low birth weight. All of them had different primary diseases. Four patients were given ventilator assisted ventilation. Six patients had central venous catheter (PICC), 8 All cases had long-term intravenous nutrition. All cases had long-term use of broad-spectrum antibiotics with more than three generations of cephalosporins. The clinical manifestations were drowsiness, feeding intolerance, bradycardia, apnea, jaundice, and even respiratory failure. 6 cases of abnormal leukocytes, 6 cases of C-reactive protein (CRP) were moderately increased, serum 1,3-β-D glucose (BG) test, 6 cases were positive changes. All 8 children received fluconazole, 7 were cured, and 1 gave up treatment. Conclusions The clinical manifestations of Candida albicans septicemia in preterm infants are not typical and laboratory tests are not specific, which is mainly related to the application of gestational age, birth weight, mechanical ventilation, deep vein catheterization, parenteral nutrition, hormones and broad-spectrum antibiotics , So early diagnosis of risk factors for early diagnosis and treatment to reduce mortality.