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目的探讨临床评估及实验室检查对早产儿医院感染早期诊断的价值。方法制定早产儿感染评分表,选择2009年1月至2010年6月在菏泽市立医院新生儿病房住院及2010年7～12月在中国医科大学绍兴医院新生儿科住院的早产儿,在抗生素使用前及治疗5天时根据临床表现进行评分,同时在应用抗生素前进行实验室检查,分为败血症组、非败血症感染组(感染组)、非感染组(对照组),对不同组别、不同评分点评分的差异、临床表现、实验室检查的特异度、敏感度、误诊率、漏诊率、正确率、阳性似然比、阴性似然比进行统计学分析。结果败血症组(27例)初始评分最高(16.2±7.2)分,感染组(39例)其次(12.4±5.3)分,对照组(52例)最低(5.3±3.2)分,3组间差异有统计学意义(P<0.05);败血症组和感染组治疗后评分明显下降(7.3±3.9)分和(6.7±3.5)分,与对照组(5.2±3.0)分比较差异无统计学意义(P>0.05)。临床表现中反应低下、喂养困难、体温异常、皮肤循环差等对诊断有重要的预测价值,其中反应低下诊断价值最高;抗生素使用前的CRP和PCT阳性似然比较高(66.8%和72.5%),诊断价值最高,PLT有一定诊断价值。结论对早产儿进行临床评估是发现医院感染的基础,常规的实验室检查有助于早产儿医院感染的早期诊断。
Objective To investigate the value of clinical assessment and laboratory tests in the early diagnosis of nosocomial infection in premature infants. Methods The score of preterm infant infection was established. Preterm infants admitted to neonatal wards of Heze Municipal Hospital from January 2009 to June 2010 and premature infants admitted to neonatology department of Shaoxing Hospital of China Medical University from July to December 2010 were enrolled. Before antibiotics The patients were divided into sepsis group, non-sepsis group (infection group) and non-infected group (control group). The scores of different groups and different grades were evaluated Points of difference, clinical manifestations, laboratory tests of specificity, sensitivity, misdiagnosis rate, missed diagnosis rate, correct rate, positive likelihood ratio, negative likelihood ratio for statistical analysis. Results The initial score of sepsis group (16 cases) was the highest (16.2 ± 7.2), the infection group (39 cases) was the second (12.4 ± 5.3) and the control group (52 cases) the lowest (5.3 ± 3.2) (P <0.05). After treatment, the score of sepsis group and infection group decreased significantly (7.3 ± 3.9) and (6.7 ± 3.5) points, respectively, but there was no significant difference between the two groups > 0.05). The clinical manifestations of low response, feeding difficulties, abnormal body temperature, poor skin circulation have important predictive value for the diagnosis, of which the low response value of the highest diagnostic value; before the use of antibiotics CRP and PCT positive likelihood (66.8% and 72.5% , The highest diagnostic value, PLT has some diagnostic value. Conclusion The clinical evaluation of preterm infants is the basis for the discovery of nosocomial infections. Conventional laboratory tests are helpful for the early diagnosis of nosocomial infections in premature infants.