新生儿重症感染毛细血管渗漏综合症11例
许平1 李宝云 杨玉军 杨春燕 周丽英 贾焕荣1
山东省聊城市人民医院新生儿ICU
目的 探讨新生儿重症感染毛细血管渗漏综合征（CLS）的临床特点、治疗措施及死亡原因。
方法 对我院新生儿重症监护病房2009年1月-2009年12月收治的11例新生儿重症感染合并CLS的临床表现、辅助检查、治疗措施及转归进行回顾性临床分析。
结果 11例患儿，男8例，女3例，胎龄30+5-40+2周，体重1210g-3600g，顺产3例，剖宫产8例，宫内窘迫史5例，生后窒息史1例，胎膜早破5例。原发病为肺炎5例，脓毒症6例，均符合全身炎性反应综合征（SIRS）的诊断标准[1]。11例患儿均为进行性皮肤、黏膜水肿、呼吸困难、不同程度感染性休克、尿少、严重低白蛋白血症（10～20g/L）；伴有意识障碍6例、肺出血6例、DIC 7例，NRDS 2例，心功能不全4例，胃肠功能不全6例；肾功能异常3例，肝功能损伤2例，伴有先天性心脏病3例，21三体2例。在控制感染、抗休克、机械通气、对症治疗及维持内环境稳定的基础上早期给予羟乙基淀粉治疗，最终抢救成功6例（54.5%），休克持续约24～72小时，水肿消失约需4～18天，机械通气时间最长31天2例，6～14天8例，神志转清约1～4天。尿量分别在4～8天后增加，死亡5例（45.5%）。
结论 毛细血管渗漏综合征是新生儿重症感染的严重并发症，死亡率高，早期在综合治疗基础上给予羟乙基淀粉可提高抢救成功率。
Object To investigate the clinical features, treatment measures and the causes of death of CLS happened on those severely infected newborns.
Method Our NICU received 11 cases of newborns who had SIRS with the complication of CLS from 2009.1 to 2009.12. We performed a retrospective analysis of the clinical manifestations, the laboratory findings, the treatment and the sequelae of the 11 cases.
Results There are 8 males and 3 femals in the 11 cases.Their gestational age varied from 30+5 weeks to 40+2 weeks and their body weights varied from 1210g to 3600g.2 of them were naturally delivered while the other 9 were delibered by cesarean section. 5 of them had the history of fetal distress ,1 of them had the history of birth asphyxia and 5 of them had the premature rupture of fetal membranes.The primary affection of 5 cases was pneumonia and that of the other 6 was sepsis.All the 11 cases comply with the diagnostic criteria with progressive edema of skin and mucosa, dyspnoea, infective shock of varied degree, oliguria and severe hypoalbuminemia（10～20g/L）.There were disturbance of consciousness in 6 cases, pulmonary hemorrhage in 6 cases,DIC in 7 cases,NRDS in 2 cases,heart dysfunction in 4 cases, gastrointestinal dysfunction in 6 cases,renal dysfunction in 3 cases,liver dysfunction in 6 cases, congenital heart disease in 3 cases and trisomy 21 in 2 cases.We treated the 11 cases with hydroxyethyl starch at an early stage under the premise of Infection controlling, anti-shock treatment, mechanical ventilation, symptomatic treatment and the maintaining of stable internal environment.At last,6 cases were rescued（54.5%）:their shock last about 24～72 hours while the edema disappeared in about 4～18 days. The duration of mechanical ventilation was varied(6～14 in 8 cases while 31 days in 2 cases)and the patients became conscious in about 1～4 days.The urine output were increased in 4 to 8 days.5 cases were died（45.5%）.
Conclusions CLS is a Severe complications of neonatal severe infection with its high mortality.Treating them with hydroxyethyl starch at an early stage can raise the success rate of rescue.
【Key words】Infant, newborn； server Infection； capillary leak
