产科机构早期和晚期新生儿脓毒症病程的临床和实验室特征

N. Kretsu, O. Koloskova, Oleksiy M. Kozma
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摘要

新生儿败血症(NS)是重症监护病房发病率和死亡率的主要原因。使用现代研究方法早期诊断新生儿脓毒性过程,可作为验证诊断的筛查方法,这一问题仍然具有相关性。对新生儿早期和晚期脓毒症的临床和实验室特征进行比较分析,以优化产科机构阶段感染-炎症过程的早期诊断。材料和方法。为了实现这一目标,回顾性分析了产科机构阶段26例新生儿的医疗记录,这些新生儿后来被转移到切尔诺夫茨的区域市政非营利企业“切尔诺夫茨地区儿童临床医院”进行治疗,表现为全身感染-炎症过程。第一组14例(53.8%)新生儿诊断为早期新生儿败血症;第二组有12例(46.2%)新生儿被诊断为晚期新生儿脓毒症(p < 0.05)。研究的结果。感染-炎症过程临床表现的特殊性应被认为是多个感染位点的结合,其中I组为57.1%,II组为16.6% (p < 0.05)。初诊心音不清和发热倾向在早期NS新生儿中更为常见:OR - 6.1 (95% CI 2.71 ~ 13.92), RR - 1.97 (95% CI 0.97 ~ 3.97), AR - 0.39和OR - 3.6 (95% CI 2.01 ~ 6.46), RR - 1.89 (95% CI 1.38 ~ 2.58), AR - 0.31。分析显示,在新生儿早期败血症中,听诊时发现心音不清(优势比- 6.1)、体温不稳定(优势比- 3.6)和绝对白细胞计数> 20.0×109/L的风险明显更高(优势比- 2.79)。
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CLINICAL AND LABORATORY FEATURES OF EARLY AND LATE NEONATAL SEPSIS COURSE AT THE STAGE OF OBSTETRIC INSTITUTIONS
Neonatal sepsis (NS) is the leading cause of morbidity and mortality in intensive care units. The issue of early diagnosis of a purulent-septic process in newborns using modern research methods that can be used as screening methods for verifying the diagnosis remains relevant. Objective. To conduct a comparative analysis of clinical and laboratory features of the course of early and late neonatal sepsis to optimize the early diagnosis of infectious-inflammatory process at the stage of obstetric institutions. Material and methods. To achieve this goal, retrospectively 26 medical records of newborns at the stage of obstetric institutions were analyzed, which were later transferred for treatment to the Regional Municipal Non-Profit Enterprise "Chernivtsi Regional Children's Clinical Hospital" in Chernivtsi with manifestations of generalized infectious-inflammatory process. The first group consisted of 14 (53.8%) newborns diagnosed with early neonatal sepsis; the second group included 12 (46.2%) newborns that were diagnosed with late neonatal sepsis (p > 0.05). Research results. Peculiarities of the clinical manifestation of the infectious-inflammatory process should be recognized as a combination of several locus of infection, which occurred in group I in 57.1% of cases, in group II – in 16.6% of cases (p < 0.05). Muffled heart sounds at the initial examination and a tendency to thermolability were more common in newborns with early NS: OR – 6.1 (95% CI 2.71–13.92), RR – 1.97 (95% CI 0.97–3.97), AR – 0.39 and OR – 3.6 (95% CI 2.01–6.46), RR – 1.89 (95% CI 1.38–2.58), AR – 0.31. Conclusion. The analysis revealed that in early neonatal sepsis the risk of detecting muffled heart sounds during auscultation (odds ratio – 6.1), unstable body temperature (odds ratio – 3.6) and absolute leukocyte count > 20.0×109/L is significantly higher (odds ratio – 2.79).
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