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目的探讨新生儿李斯特菌败血症的临床特点及诊治。方法回顾性分析2008年1月至2013年6月于我院新生儿重症监护病房收治、血培养阳性的产单核细胞增生性李斯特菌败血症新生儿,记录母亲孕产史,患儿围产期情况、临床表现、实验室检查、治疗经过及预后等,结合相关文献对新生儿产单核细胞增生性李斯特菌败血症临床特点进行探讨。结果共收治10例新生儿李斯特菌败血症患儿,男8例,女2例;早产儿3例;48h内发病8例,>7天发病2例;母亲围产期发热6例;羊水异常10例。临床表现:10例均反应差,呼吸异常7例,发热5例,惊厥2例,休克1例。实验室检查:血WBC升高(>19.5×109/L)6例,降低2例(<5×109/L),正常2例。白细胞分类单核细胞百分比升高10例;CPR升高10例。血培养产单核细胞增生性李斯特菌10例,合并化脓性脑膜炎3例。治疗:美罗培南8例,青霉素加头孢类抗生素2例;转归:治愈7例,好转1例,自动出院后死亡2例。结论新生儿李斯特菌败血症病情凶险,病死率高,对于有高危因素的新生儿应作为重点监护对象,血常规中白细胞分类单核细胞百分比>8%、脑脊液常规白细胞以单核细胞为主者,应高度怀疑单核细胞增生性李斯特菌败血症,做到早发现、早治疗。
Objective To investigate the clinical features, diagnosis and treatment of neonatal Listeria septicemia. Methods Retrospective analysis of neonatal mononuclear Listeria monocytogenes septicemia neonatal intensive care unit admitted to our hospital from January 2008 to June 2013, blood culture positive, record maternal history of pregnancy, children with perinatal Period, clinical manifestations, laboratory tests, treatment and prognosis, combined with the literature on neonatal Listeria monocytogenes sepsis clinical features are discussed. Results A total of 10 neonates with Listeria septicemia were treated, including 8 males and 2 females, 3 preterm infants, 8 infants within 48 h, 2 morbidities> 7 days, 6 maternal perinatal fever, 10 cases. Clinical manifestations: 10 cases were poor response, respiratory abnormalities in 7 cases, fever in 5 cases, 2 cases of convulsions, shock in 1 case. Laboratory tests: blood WBC increased (> 19.5 × 109 / L) in 6 cases, decreased in 2 cases (<5 × 109 / L), normal in 2 cases. White blood cell classification monocyte percentage increased in 10 cases; CPR increased in 10 cases. Blood culture produced Listeria monocytogenes in 10 cases, combined purulent meningitis in 3 cases. Treatment: Meropenem in 8 cases, penicillin and cephalosporin antibiotics in 2 cases; outcome: cured in 7 cases, improved in 1 case, 2 cases were discharged from hospital automatically. Conclusion Neonatal Listeria septicemia is extremely dangerous and has a high case fatality rate. Newborns with high-risk factors should be the target of intensive care. The percentage of white blood cell mononuclear cells in blood routine is more than 8%, and that of normal cerebrospinal fluid leukocytes is mainly mononuclear cells , Should be highly suspected Listeria monocytogenes sepsis, early detection and early treatment.