摘要目的 分析早产儿近平滑念珠菌性脓毒症的临床特点,为其诊治及预防提供参考依据.方法 对9例确诊为近平滑念珠菌性脓毒症早产儿的临床资料进行回顾性分析.结果 9例近平滑念珠菌性脓毒症患儿均为＜ 37周早产儿,占同期出院早产儿的0.73％,体质量(1 621.00±372.22)g,极低出生体质量儿5例,低出生体质量儿4例.发生真菌感染时日龄(22.00±7.58)d.9例均予静脉营养,感染前接受广谱抗生素治疗7例,7例曾行机械通气,7例行外周中心静脉置管(PICC),1例曾行外科手术.临床表现有反应差、血氧饱和度波动、皮肤黄染、灌注差(肢端凉)、腹胀、发热、发绀、体质量不增等症状.辅助检查中白细胞计数正常6例,C反应蛋白明显升高6例,血小板降低6例,9例血浆(1-3)-β-D葡聚糖升高.所有病例均接受氟康唑抗真菌及对症支持治疗,2例未能坚持住院治疗但带药出院并坚持院外治疗,定期随访,所有患儿预后良好,无一例死亡.结论 早产儿近平滑念珠菌性脓毒症中,高危因素包括胎龄、出生体质量、是否长期应用广谱抗生素、机械通气、外周中心静脉置管等,可伴有白细胞计数正常、血小板减少、C反应蛋白升高、血浆(1-3)-β-D葡聚糖增高等,氟康唑治疗效果良好.

abstractsObjective To analyze the clinical characteristics of Candida parapsilosis septicemia of prematurity and provide a reference for both diagnosis and treatment.Methods The clinical data of 9 premature suffering with candida parapsilosis septicemia were retrospectively analyzed.Results All 9 cases (0.73 percent in the corresponding period) were premature infants with gestational age less than 37 weeks.The average weight of the patients was (1 621.00 ±372.22) g,among which 5 cases were of very low birth weight and 4 cases were of low birth weight.The average time of the fungi infection was (22.00 ± 7.58) d.Of the 9 cases,7 cases had been treated with broad spectrum antibiotics previously,9 cases were given nutrition intravenously,7 cases were treated with mechanical ventilation,7 cases adopted peripherally inserted central catheter(PICC) and 1 case received surgery.The symptoms included poor response,unstable serum oxygen saturation,jaundice,poor perfusion,abdominal distention,fever and no bodyweight increase.Laboratory tests results presented platelet decrease(6 cases),C-reaction protein increase (6 cases),high plasma (1-3)-β-D glucan level(9 cases) and white blood cells in the normal range(6 cases).All 9 infants recovered after receiving fluconazole and supporting treatment.Two cases failed to complete the hospital treatment but after discharge from hospital continued treatment by administering prescribed medicine,and through regular follow-up was done,the prognosis of all cases turned out to be good,and no case died.Conclusions Gestational age,birth weight,application of broad spectrum antibiotics,mechanical ventilation and peripherally inserted central catheter are common high risk factors of Candida parapsilosis septicemia in premature infants.The disease was featured with normal white blood cell,low platelet,high serum levels of C-reaction protein and (1-3)-β-D glucan.Anti-fungi therapy with fluconazole may be a good choice for it.