Article(id=1322923537169784878, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322923490592043032, articleNumber=null, orderNo=null, doi=10.13193/j.issn.1673-7717.2025.05.007, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=null, receivedDateStr=null, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793339149992, onlineDateStr=2026-10-30, pubDate=1746806400000, pubDateStr=2025-05-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793339149992, onlineIssueDateStr=2026-10-30, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793339149992, creator=13701087609, updateTime=1793339149992, updator=13701087609, issue=Issue{id=1322923490592043032, tenantId=1146029695717560320, journalId=1255847919539208197, year='2025', volume='43', issue='5', pageStart='1', pageEnd='258', issueExtLink='null', onlineDate='null', pubDate='1746806400000', pubDateStr='2025-05-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1793339138887, creator='13701087609', updateTime=1793340572227, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322929502539612595, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322923490592043032, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322929502539612596, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322923490592043032, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=32, endPage=34, ext={EN=ArticleExt(id=1322923537354334255, articleId=1322923537169784878, tenantId=1146029695717560320, journalId=1255847919539208197, language=EN, title=Characteristics of Carbapenem Resistant Klebsiella Pneumoniae Sepsis in Children and Research Progress on Traditional Chinese Medicine Treatment, columnId=1256183361521967297, journalTitle=Chinese Archives of Traditional Chinese Medicine, columnName=Target on National Project, runingTitle=null, highlight=null, articleAbstract=

In recentyears,with thewide application of antibacterial drugs,their drug resistance is rising,and the development of drug resistance is far greater than the development of antibacterial drugs,leading to a serious threat to human life and health and increasing the economic burden ofmedical and health care. The detection rate of carbapenem resistant Klebsiella pneumoniae(CRKP)in pediatric wards in China is increasing. CRPK sepsis in children lacks specific clinicalmanifestations,and its onset is hidden. But it has strong pathogenicity and rapid progression,and is prone tomultiple organ failure. Carbapenem antibiotics are still themainmeans to treat CRKP infection. With the in-depth study of CRKP sepsis in traditional Chinesemedicine,more and more attention has been paid to the treatment of CRKP sepsis with traditional Chinesemedicine. This article aimed to review the characteristics of carbapenem resistant Klebsiella pneumoniae sepsis in children and the research progress of traditional Chinese medicine treatment.

, authors=Yan WANG, Jingjing LING, Danli ZHOU, Huanqing GE, authorsList=Yan WANG, Jingjing LING, Danli ZHOU, Huanqing GE, authorCompany=null, correspAuthors=null, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322923537920565298, articleId=1322923537169784878, tenantId=1146029695717560320, journalId=1255847919539208197, language=CN, title=儿童耐碳青霉烯类肺炎克雷伯杆菌脓毒症特点以及中医治疗的研究进展, columnId=1256183362172142382, journalTitle=中华中医药学刊, columnName=国家项目点击, runingTitle=null, highlight=null, articleAbstract=

随着近年来抗菌药物的广泛应用,其耐药性不断上升,耐药发展远大于抗菌药物的研发,严重威胁人类生命,加重医疗卫生经济负担。我国儿科病房对耐碳青霉烯类肺炎克雷伯杆菌(Carbapenem resistant Klebsiella pneumoniae,CRKP)检出率不断增长。儿童CRPK脓毒症缺乏特异临床表现,起病隐匿,但致病性强、进展迅速,容易出现多器官衰竭等。碳青霉烯类抗菌药物仍为治疗CRKP感染的主要手段。随着中医对CRKP脓毒症的深入研究,中医药用于CRKP脓毒症方面的治疗越来越受到重视。对儿童耐碳青霉烯类肺炎克雷伯杆菌脓毒症特点以及中医治疗的研究进展作一综述。

, authors=王燕, 凌菁菁, 周丹丽, 葛焕青, authorsList=王燕, 凌菁菁, 周丹丽, 葛焕青, authorCompany=null, correspAuthors=null, authorNote=

王燕(1978-),女,江苏连云港人,主任药师,硕士,研究方向:药事管理、临床药学(儿科)。

, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=i4VDgfu+V6bC4qLrrbUX3A==, magXml=HAbkpkhjwDVWx8X6FNGunA==, pdfUrl=null, pdf=4rkHw+YDxbQek1X75PPbdw==, pdfFileSize=1614704, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=vCqgvO0vCa/TuWv2TfpdEw==, mapNumber=null, fund=null)}, authors=[Author(id=1322923538201583671, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, orderNo=0, firstName=null, middleName=null, lastName=null, nameCn=null, orcid=null, stid=null, country=null, authorPic=null, dead=0, email=null, emailSecond=null, emailThird=null, correspondingAuthor=0, authorType=1, ext={EN=AuthorExt(id=1322923538298052665, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, authorId=1322923538201583671, language=EN, stringName=Yan WANG, firstName=Yan, middleName=null, lastName=WANG, prefix=null, suffix=null, authorComment=null, nameInitials=null, affiliation=null, department=null, xref=null, address=Wuxi Children's Hospital,Wuxi 214000,Jiangsu,China, bio=null, bioImg=null, bioContent=null, aboutCorrespAuthor=null), CN=AuthorExt(id=1322923538356772922, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, authorId=1322923538201583671, language=CN, stringName=王燕, firstName=null, middleName=null, lastName=null, prefix=null, suffix=null, authorComment=null, nameInitials=null, affiliation=null, department=null, xref=null, address=无锡市儿童医院,江苏 无锡 214000, bio={"content":"

王燕(1978-),女,江苏连云港人,主任药师,硕士,研究方向:药事管理、临床药学(儿科)。

"}, bioImg=null, bioContent=

王燕(1978-),女,江苏连云港人,主任药师,硕士,研究方向:药事管理、临床药学(儿科)。

, aboutCorrespAuthor=null)}, companyList=[AuthorCompany(id=1322923538113503283, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, xref=null, ext=[AuthorCompanyExt(id=1322923538121891892, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, companyId=1322923538113503283, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Wuxi Children's Hospital,Wuxi 214000,Jiangsu,China), AuthorCompanyExt(id=1322923538126086197, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, companyId=1322923538113503283, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=无锡市儿童医院,江苏 无锡 214000)])]), Author(id=1322923538423881788, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, orderNo=1, firstName=null, middleName=null, lastName=null, nameCn=null, orcid=null, stid=null, country=null, authorPic=null, dead=0, email=null, emailSecond=null, emailThird=null, correspondingAuthor=0, authorType=1, ext={EN=AuthorExt(id=1322923538490990654, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, authorId=1322923538423881788, language=EN, stringName=Jingjing LING, firstName=Jingjing, middleName=null, lastName=LING, prefix=null, suffix=null, authorComment=null, nameInitials=null, affiliation=null, department=null, xref=null, address=Wuxi Children's Hospital,Wuxi 214000,Jiangsu,China, bio=null, bioImg=null, bioContent=null, aboutCorrespAuthor=null), CN=AuthorExt(id=1322923538558099519, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, authorId=1322923538423881788, language=CN, stringName=凌菁菁, firstName=null, middleName=null, lastName=null, prefix=null, suffix=null, authorComment=null, nameInitials=null, affiliation=null, department=null, xref=null, address=无锡市儿童医院,江苏 无锡 214000, bio=null, bioImg=null, bioContent=null, aboutCorrespAuthor=null)}, companyList=[AuthorCompany(id=1322923538113503283, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, xref=null, ext=[AuthorCompanyExt(id=1322923538121891892, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, companyId=1322923538113503283, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Wuxi Children's Hospital,Wuxi 214000,Jiangsu,China), AuthorCompanyExt(id=1322923538126086197, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, companyId=1322923538113503283, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=无锡市儿童医院,江苏 无锡 214000)])]), Author(id=1322923538629402689, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, orderNo=2, firstName=null, middleName=null, lastName=null, nameCn=null, orcid=null, stid=null, country=null, authorPic=null, dead=0, email=null, emailSecond=null, emailThird=null, correspondingAuthor=0, authorType=1, ext={EN=AuthorExt(id=1322923538696511555, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, authorId=1322923538629402689, language=EN, stringName=Danli ZHOU, firstName=Danli, middleName=null, lastName=ZHOU, prefix=null, suffix=null, authorComment=null, nameInitials=null, affiliation=null, department=null, xref=null, address=Wuxi Children's Hospital,Wuxi 214000,Jiangsu,China, bio=null, bioImg=null, bioContent=null, aboutCorrespAuthor=null), CN=AuthorExt(id=1322923538772009028, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, authorId=1322923538629402689, language=CN, stringName=周丹丽, firstName=null, middleName=null, lastName=null, prefix=null, suffix=null, authorComment=null, nameInitials=null, affiliation=null, department=null, xref=null, address=无锡市儿童医院,江苏 无锡 214000, bio=null, bioImg=null, bioContent=null, aboutCorrespAuthor=null)}, companyList=[AuthorCompany(id=1322923538113503283, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, xref=null, ext=[AuthorCompanyExt(id=1322923538121891892, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, companyId=1322923538113503283, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Wuxi Children's Hospital,Wuxi 214000,Jiangsu,China), AuthorCompanyExt(id=1322923538126086197, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, companyId=1322923538113503283, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=无锡市儿童医院,江苏 无锡 214000)])]), Author(id=1322923538839117894, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, orderNo=3, firstName=null, middleName=null, lastName=null, nameCn=null, orcid=null, stid=null, country=null, authorPic=null, dead=0, email=null, emailSecond=null, emailThird=null, correspondingAuthor=0, authorType=1, ext={EN=AuthorExt(id=1322923538943975496, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, authorId=1322923538839117894, language=EN, stringName=Huanqing GE, firstName=Huanqing, middleName=null, lastName=GE, prefix=null, suffix=null, authorComment=null, nameInitials=null, affiliation=null, department=null, xref=null, address=Wuxi Children's Hospital,Wuxi 214000,Jiangsu,China, bio=null, bioImg=null, bioContent=null, aboutCorrespAuthor=null), CN=AuthorExt(id=1322923539048833097, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, authorId=1322923538839117894, language=CN, stringName=葛焕青, firstName=null, middleName=null, lastName=null, prefix=null, suffix=null, authorComment=null, nameInitials=null, affiliation=null, department=null, xref=null, address=无锡市儿童医院,江苏 无锡 214000, bio=null, bioImg=null, bioContent=null, aboutCorrespAuthor=null)}, companyList=[AuthorCompany(id=1322923538113503283, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, xref=null, ext=[AuthorCompanyExt(id=1322923538121891892, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, companyId=1322923538113503283, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Wuxi Children's Hospital,Wuxi 214000,Jiangsu,China), AuthorCompanyExt(id=1322923538126086197, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, companyId=1322923538113503283, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=无锡市儿童医院,江苏 无锡 214000)])])], keywords=[Keyword(id=1322923540772692042, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, language=EN, orderNo=1, keyword=carbapenems resistant children), Keyword(id=1322923540869161035, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, language=EN, orderNo=2, keyword=Klebsiella pneumoniae), Keyword(id=1322923540927881292, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, language=EN, orderNo=3, keyword=sepsis), Keyword(id=1322923541011767373, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, language=EN, orderNo=4, keyword=traditional Chinesemedicine), Keyword(id=1322923541091459150, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, language=EN, orderNo=5, keyword=research progress), Keyword(id=1322923541158568015, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, language=CN, orderNo=1, keyword=儿童耐碳青霉烯类), Keyword(id=1322923541246648400, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, language=CN, orderNo=2, keyword=肺炎克雷伯杆菌), Keyword(id=1322923541309562962, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, language=CN, orderNo=3, keyword=脓毒症), Keyword(id=1322923541376671828, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, language=CN, orderNo=4, keyword=中医), Keyword(id=1322923541473140821, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, language=CN, orderNo=5, keyword=研究进展)], refs=[Reference(id=1322923541821268057, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, doi=null, pmid=null, pmcid=null, year=2021, volume=44, issue=6, pageStart=2143, pageEnd=2150, url=null, language=null, rfNumber=[1], rfOrder=0, authorNames=GAO Q Z, HERNANDESM S, journalName=Inflammation, refType=null, unstructuredReference=GAO Q Z,HERNANDESM S. Sepsis-associated encephalopathy and blood-brain barrier dysfunction[J]. Inflammation,2021,44(6):2143-2150., articleTitle=Sepsis-associated encephalopathy and blood-brain barrier dysfunction, refAbstract=null), Reference(id=1322923541879988314, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, doi=null, pmid=null, pmcid=null, year=2023, volume=39, issue=22, pageStart=2958, pageEnd=2963, url=null, language=null, rfNumber=[2], rfOrder=1, authorNames=常晨阳, 胡绍雯, 邓国平, journalName=实用医学杂志, refType=null, unstructuredReference=常晨阳,胡绍雯,邓国平,等. 中性粒细胞计数与淋巴细胞和血小板计数比值在儿童脓毒症预后中的预测价值[J]. 实用医学杂志,2023,39(22):2958-2963., articleTitle=中性粒细胞计数与淋巴细胞和血小板计数比值在儿童脓毒症预后中的预测价值, refAbstract=null), Reference(id=1322923541955485787, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, doi=null, pmid=null, pmcid=null, year=2021, volume=34, issue=2, pageStart=71, pageEnd=76, url=null, language=null, rfNumber=[3], rfOrder=2, authorNames=CHIU C, LEGRAND M, journalName=Curr Opin Anaesthesiol, refType=null, unstructuredReference=CHIU C,LEGRAND M. Epidemiology of sepsis and septic shock[J]. Curr Opin Anaesthesiol,2021,34(2):71-76., articleTitle=Epidemiology of sepsis and septic shock, refAbstract=null), Reference(id=1322923542026788956, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, doi=null, pmid=null, pmcid=null, year=2023, volume=25, issue=9, pageStart=941, pageEnd=946, url=null, language=null, rfNumber=[4], rfOrder=3, authorNames=彭智慧, 颜海鹏, 卢秀兰, journalName=中国当代儿科杂志, refType=null, unstructuredReference=彭智慧,颜海鹏,卢秀兰,等. 补体C3对儿童脓毒症患者预后的预测价值[J]. 中国当代儿科杂志,2023,25(9):941-946., articleTitle=补体C3对儿童脓毒症患者预后的预测价值, refAbstract=null), Reference(id=1322923542119063645, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, doi=null, pmid=null, pmcid=null, year=2020, volume=41, issue=4, pageStart=34, pageEnd=37,41, url=null, language=null, rfNumber=[5], rfOrder=4, authorNames=魏徐鹏, 丁娟娟, journalName=医药论坛杂志, refType=null, unstructuredReference=魏徐鹏,丁娟娟. 耐碳青霉烯类肺炎克雷伯菌血流感染危险因素分析[J]. 医药论坛杂志,2020,41(4):34-37,41., articleTitle=耐碳青霉烯类肺炎克雷伯菌血流感染危险因素分析, refAbstract=null), Reference(id=1322923542207144030, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, doi=null, pmid=null, pmcid=null, year=2020, volume=41, issue=8, pageStart=799, pageEnd=804, url=null, language=null, rfNumber=[6], rfOrder=5, authorNames=刘长鑫, 张侃, 王博, journalName=解放军医学院学报, refType=null, unstructuredReference=刘长鑫,张侃,王博,等. 血流感染碳青霉烯耐药肺炎克雷伯杆菌的危险因素及预后分析[J]. 解放军医学院学报,2020,41(8):799-804., articleTitle=血流感染碳青霉烯耐药肺炎克雷伯杆菌的危险因素及预后分析, refAbstract=null), Reference(id=1322923542282641503, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, doi=null, pmid=null, pmcid=null, year=2021, volume=10, issue=1, pageStart=1129, pageEnd=1136, url=null, language=null, rfNumber=[7], rfOrder=6, authorNames=JIN X, CHEN Q, SHEN F, journalName=Emerg Microbes Infect, refType=null, unstructuredReference=JIN X,CHEN Q,SHEN F,et al. Resistance evolution of hypervirulent carbapenem-resistant Klebsiella pneumoniae ST11 during treatment with tigecycline and polymyxin[J]. Emerg Microbes Infect,2021,10(1):1129-1136., articleTitle=Resistance evolution of hypervirulent carbapenem-resistant Klebsiella pneumoniae ST11 during treatment with tigecycline and polymyxin, refAbstract=null), Reference(id=1322923542370721888, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, doi=null, pmid=null, pmcid=null, year=2021, volume=20, issue=12, pageStart=1282, pageEnd=1286, url=null, language=null, rfNumber=[8], rfOrder=7, authorNames=龙晓琴, journalName=疑难病杂志, refType=null, unstructuredReference=龙晓琴. 耐碳青霉烯类肺炎克雷伯杆菌感染的研究进展[J]. 疑难病杂志,2021,20(12):1282-1286., articleTitle=耐碳青霉烯类肺炎克雷伯杆菌感染的研究进展, refAbstract=null), Reference(id=1322923542492356705, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, doi=null, pmid=null, pmcid=null, year=2021, volume=52, issue=4, pageStart=1913, pageEnd=1919, url=null, language=null, rfNumber=[9], rfOrder=8, authorNames=RODRIGUESD, BALDISSERA G S, MATHOSD, journalName=Braz JMicrobiol, refType=null, unstructuredReference=RODRIGUESD,BALDISSERA G S,MATHOSD,et al. Amikacin for the treatment of carbapenem-resistant Klebsiella pneumoniae infections:clinical efficacy and toxicity[J]. Braz JMicrobiol,2021,52(4):1913-1919., articleTitle=Amikacin for the treatment of carbapenem-resistant Klebsiella pneumoniae infections:clinical efficacy and toxicity, refAbstract=null), Reference(id=1322923542681100386, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, doi=null, pmid=null, pmcid=null, year=2018, volume=6, issue=3, pageStart=223, pageEnd=230, url=null, language=null, rfNumber=[10], rfOrder=9, authorNames=FLEISCHMANN-STRUZEK C, GOLDFARB D M, SCHLATTMANN P, journalName=Lancet Respir Med, refType=null, unstructuredReference=FLEISCHMANN-STRUZEK C,GOLDFARB D M,SCHLATTMANN P,etal. The globalburden of paediatric and neonatal sepsis:a systematic review[J]. Lancet Respir Med,2018,6(3):223-230., articleTitle=The globalburden of paediatric and neonatal sepsis:a systematic review, refAbstract=null), Reference(id=1322923542773375075, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, doi=null, pmid=null, pmcid=null, year=2015, volume=191, issue=10, pageStart=1147, pageEnd=1157, url=null, language=null, rfNumber=[11], rfOrder=10, authorNames=WEISSSL, FITZGERALD JC, PAPPACHAN J, journalName=Am JRespir Crit Care Med, refType=null, unstructuredReference=WEISSSL,FITZGERALD JC,PAPPACHAN J,etal. Global epidemiology of pediatric severe sepsis:the sepsis prevalence,outcomes,and therapiesstudy[J]. Am JRespir Crit Care Med,2015,191(10):1147-1157., articleTitle=Global epidemiology of pediatric severe sepsis:the sepsis prevalence,outcomes,and therapiesstudy, refAbstract=null), Reference(id=1322923542840483940, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, doi=null, pmid=null, pmcid=null, year=2016, volume=52, issue=10, pageStart=939, pageEnd=943, url=null, language=null, rfNumber=[12], rfOrder=11, authorNames=LU Q, ZHOU M, TU Y, journalName=JPaediatr Child Health, refType=null, unstructuredReference=LU Q,ZHOU M,TU Y,et al. Pathogen and antimicrobial resistance profiles of culture-proven neonatal sepsis in Southwest China,1990-2014[J]. JPaediatr Child Health,2016,52(10):939-943., articleTitle=Pathogen and antimicrobial resistance profiles of culture-proven neonatal sepsis in Southwest China,1990-2014, refAbstract=null), Reference(id=1322923542915981413, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, doi=null, pmid=null, pmcid=null, year=2020, volume=21, issue=2, pageStart=e52, pageEnd=e106, url=null, language=null, rfNumber=[13], rfOrder=12, authorNames=WEISSSL, PETERSM J, ALHAZZANIW, journalName=Pediatr Crit Care Med, refType=null, unstructuredReference=WEISSSL,PETERSM J,ALHAZZANIW,etal. Surviving sepsis campaign international guidelines for themanagementof septic shock and sepsis-associated organ dysfunction in children[J]. Pediatr Crit Care Med,2020,21(2):e52-e106., articleTitle=Surviving sepsis campaign international guidelines for themanagementof septic shock and sepsis-associated organ dysfunction in children, refAbstract=null), Reference(id=1322923542983090278, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, doi=null, pmid=null, pmcid=null, year=2023, volume=34, issue=4, pageStart=104, pageEnd=108, url=null, language=null, rfNumber=[14], rfOrder=13, authorNames=胡语航, 任新蕊, 徐静, journalName=中国妇幼健康研究, refType=null, unstructuredReference=胡语航,任新蕊,徐静,等. 改良qSOFA评分对儿童脓毒症的诊断效能及分诊价值[J]. 中国妇幼健康研究,2023,34(4):104-108., articleTitle=改良qSOFA评分对儿童脓毒症的诊断效能及分诊价值, refAbstract=null), Reference(id=1322923543079559271, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, doi=null, pmid=null, pmcid=null, year=2023, volume=61, issue=3, pageStart=222, pageEnd=227, url=null, language=null, rfNumber=[15], rfOrder=14, authorNames=项龙, 李娟珍, 周景艺, journalName=中华儿科杂志, refType=null, unstructuredReference=项龙,李娟珍,周景艺,等. 新型凝血生物标志物评价儿童脓毒症的临床价值[J]. 中华儿科杂志,2023,61(3):222-227., articleTitle=新型凝血生物标志物评价儿童脓毒症的临床价值, refAbstract=null), Reference(id=1322923543163445352, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, doi=null, pmid=null, pmcid=null, year=2021, volume=59, issue=5, pageStart=368, pageEnd=373, url=null, language=null, rfNumber=[16], rfOrder=15, authorNames=奚悦玲, 任宏, 张建, journalName=中华儿科杂志, refType=null, unstructuredReference=奚悦玲,任宏,张建,等. 儿童脓毒症院内感染相关免疫指标分析[J]. 中华儿科杂志,2021,59(5):368-373., articleTitle=儿童脓毒症院内感染相关免疫指标分析, refAbstract=null), Reference(id=1322923543226359913, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, doi=null, pmid=null, pmcid=null, year=2021, volume=27, issue=1, pageStart=29, pageEnd=32, url=null, language=null, rfNumber=[17], rfOrder=16, authorNames=刘拥荣, 贺立飞, 余亚敏, journalName=内科急危重症杂志, refType=null, unstructuredReference=刘拥荣,贺立飞,余亚敏,等. 114株耐碳氢酶烯肺炎克雷伯杆菌耐药表型及基因分析[J]. 内科急危重症杂志,2021,27(1):29-32., articleTitle=114株耐碳氢酶烯肺炎克雷伯杆菌耐药表型及基因分析, refAbstract=null), Reference(id=1322923543314440298, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, doi=null, pmid=null, pmcid=null, year=2009, volume=9, issue=5, pageStart=321, pageEnd=329, url=null, language=null, rfNumber=[18], rfOrder=17, authorNames=汪复, 朱德妹, 胡付品, journalName=中国感染与化疗杂志, refType=null, unstructuredReference=汪复,朱德妹,胡付品,等. 2008年中国CHINET细菌耐药性监测[J]. 中国感染与化疗杂志,2009,9(5):321-329., articleTitle=2008年中国CHINET细菌耐药性监测, refAbstract=null), Reference(id=1322923543398326379, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, doi=null, pmid=null, pmcid=null, year=2014, volume=14, issue=5, pageStart=365, pageEnd=374, url=null, language=null, rfNumber=[19], rfOrder=18, authorNames=胡付品, 朱德妹, 汪复, journalName=中国感染与化疗杂志, refType=null, unstructuredReference=胡付品,朱德妹,汪复,等. 2013年中国CHINET细菌耐药性监测[J]. 中国感染与化疗杂志,2014,14(5):365-374., articleTitle=2013年中国CHINET细菌耐药性监测, refAbstract=null), Reference(id=1322923543461240940, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, doi=null, pmid=null, pmcid=null, year=2022, volume=30, issue=4, pageStart=315, pageEnd=318, url=null, language=null, rfNumber=[20], rfOrder=19, authorNames=张莉, 胡淼, 陈媛, journalName=药学与临床研究, refType=null, unstructuredReference=张莉,胡淼,陈媛,等. 耐碳青霉烯类肺炎克雷伯杆菌肺部感染患者不同抗菌药物联合治疗方案的疗效与安全性分析[J]. 药学与临床研究,2022,30(4):315-318., articleTitle=耐碳青霉烯类肺炎克雷伯杆菌肺部感染患者不同抗菌药物联合治疗方案的疗效与安全性分析, refAbstract=null), Reference(id=1322923543536738413, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, doi=null, pmid=null, pmcid=null, year=2019, volume=48, issue=12, pageStart=103, pageEnd=107, url=null, language=null, rfNumber=[21], rfOrder=20, authorNames=陈泗虎, 李凯, 张胜翔, journalName=医学研究杂志, refType=null, unstructuredReference=陈泗虎,李凯,张胜翔,等. 儿童产ESBLs肺炎克雷伯菌耐药性及基因型研究[J]. 医学研究杂志,2019,48(12):103-107., articleTitle=儿童产ESBLs肺炎克雷伯菌耐药性及基因型研究, refAbstract=null), Reference(id=1322923545210265710, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, doi=null, pmid=null, pmcid=null, year=2022, volume=11, issue=1, pageStart=841, pageEnd=849, url=null, language=null, rfNumber=[22], rfOrder=21, authorNames=YANG X M, SUN Q L, LI JP, journalName=Emerg Microbes Infect, refType=null, unstructuredReference=YANG X M,SUN Q L,LI JP,et al. Molecular epidemiology of carbapenem-resistant hypervirulent Klebsiella pneumoniae in China[J]. Emerg Microbes Infect,2022,11(1):841-849., articleTitle=Molecular epidemiology of carbapenem-resistant hypervirulent Klebsiella pneumoniae in China, refAbstract=null), Reference(id=1322923545273180271, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, doi=null, pmid=null, pmcid=null, year=2020, volume=null, issue=2, pageStart=145, pageEnd=149, url=null, language=null, rfNumber=[23], rfOrder=22, authorNames=安翔宇, 谢伟峰, 郑旭, journalName=中华危重病急救医学, refType=null, unstructuredReference=安翔宇,谢伟峰,郑旭,等. 青岛市区5家医院耐碳青霉烯类肺炎克雷伯杆菌耐药基因检测及分析[J]. 中华危重病急救医学,2020(2):145-149., articleTitle=青岛市区5家医院耐碳青霉烯类肺炎克雷伯杆菌耐药基因检测及分析, refAbstract=null), Reference(id=1322923545344483440, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, doi=null, pmid=null, pmcid=null, year=2020, volume=27, issue=12, pageStart=893, pageEnd=898, url=null, language=null, rfNumber=[24], rfOrder=23, authorNames=李珍, 朱月钮, 许莉莉, journalName=中国小儿急救医学, refType=null, unstructuredReference=李珍,朱月钮,许莉莉,等. 多黏菌素治疗小儿重症耐碳青霉烯类革兰阴性菌感染的临床疗效观察[J]. 中国小儿急救医学,2020,27(12):893-898., articleTitle=多黏菌素治疗小儿重症耐碳青霉烯类革兰阴性菌感染的临床疗效观察, refAbstract=null), Reference(id=1322923545428369521, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, doi=null, pmid=null, pmcid=null, year=2022, volume=22, issue=3, pageStart=401, pageEnd=412, url=null, language=null, rfNumber=[25], rfOrder=24, authorNames=WANG M G, EARLEY M, CHEN L, journalName=Lancet Infect Dis, refType=null, unstructuredReference=WANG M G,EARLEY M,CHEN L,et al. Clinical outcomes and bacterial characteristics of carbapenem-resistant Klebsiella pneumoniae complex among patients from different global regions(CRACKLE-2):a prospective,multicentre,cohort study[J]. Lancet Infect Dis,2022,22(3):401-412., articleTitle=Clinical outcomes and bacterial characteristics of carbapenem-resistant Klebsiella pneumoniae complex among patients from different global regions(CRACKLE-2):a prospective,multicentre,cohort study, refAbstract=null), Reference(id=1322923545529032818, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, doi=null, pmid=null, pmcid=null, year=2021, volume=10, issue=1, pageStart=700, pageEnd=709, url=null, language=null, rfNumber=[26], rfOrder=25, authorNames=YANG Y Q, YANG Y X, CHEN G P, journalName=Emerg Microbes Infect, refType=null, unstructuredReference=YANG Y Q,YANG Y X,CHEN G P,et al. Molecular characterization of carbapenem-resistant and virulent plasmids in Klebsiella pneumoniae from patients with bloodstream infections in China[J]. Emerg Microbes Infect,2021,10(1):700-709., articleTitle=Molecular characterization of carbapenem-resistant and virulent plasmids in Klebsiella pneumoniae from patients with bloodstream infections in China, refAbstract=null), Reference(id=1322923545612918899, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, doi=null, pmid=null, pmcid=null, year=2016, volume=25, issue=5, pageStart=504, pageEnd=506, url=null, language=null, rfNumber=[27], rfOrder=26, authorNames=杨青美, 谭从容, journalName=现代中西医结合杂志, refType=null, unstructuredReference=杨青美,谭从容. 中西医结合治疗婴幼儿肺炎克雷伯杆菌肺炎临床疗效观察[J]. 现代中西医结合杂志,2016,25(5):504-506., articleTitle=中西医结合治疗婴幼儿肺炎克雷伯杆菌肺炎临床疗效观察, refAbstract=null), Reference(id=1322923545688416372, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, doi=null, pmid=null, pmcid=null, year=2012, volume=50, issue=3, pageStart=178, pageEnd=183, url=null, language=null, rfNumber=[28], rfOrder=27, authorNames=北京地区PICU脓毒症调查协作组, journalName=中华儿科杂志, refType=null, unstructuredReference=北京地区PICU脓毒症调查协作组. 北京地区两家医院儿科重症监护病房486例脓毒症分析[J]. 中华儿科杂志,2012,50(3):178-183., articleTitle=北京地区两家医院儿科重症监护病房486例脓毒症分析, refAbstract=null), Reference(id=1322923545759719541, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, doi=null, pmid=null, pmcid=null, year=2022, volume=50, issue=2, pageStart=156, pageEnd=159, url=null, language=null, rfNumber=[29], rfOrder=28, authorNames=回广飞, 马德宾, 栾亮, journalName=临床军医杂志, refType=null, unstructuredReference=回广飞,马德宾,栾亮,等. 耐碳青霉烯类肺炎克雷伯菌联合给药方案对医院获得性肺炎疗效及安全性分析[J]. 临床军医杂志,2022,50(2):156-159., articleTitle=耐碳青霉烯类肺炎克雷伯菌联合给药方案对医院获得性肺炎疗效及安全性分析, refAbstract=null), Reference(id=1322923545839411318, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, doi=null, pmid=null, pmcid=null, year=2011, volume=6, issue=2, pageStart=216, pageEnd=218, url=null, language=null, rfNumber=[30], rfOrder=29, authorNames=任鹏, 潘健, 刘志远, journalName=中国医药, refType=null, unstructuredReference=任鹏,潘健,刘志远,等. 黄连水煎剂对产超广谱β内酰胺酶肺炎克雷伯杆菌的抑菌作用[J]. 中国医药,2011,6(2):216-218., articleTitle=黄连水煎剂对产超广谱β内酰胺酶肺炎克雷伯杆菌的抑菌作用, refAbstract=null), Reference(id=1322923545919103095, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, doi=null, pmid=null, pmcid=null, year=2011, volume=18, issue=4, pageStart=306, pageEnd=308, url=null, language=null, rfNumber=[31], rfOrder=30, authorNames=雷澍, 江荣林, 朱美飞, journalName=中国中医药科技, refType=null, unstructuredReference=雷澍,江荣林,朱美飞,等. 黄芪对肺炎克雷伯菌肺炎大鼠胸腺细胞凋亡及相关基因表达的影响[J]. 中国中医药科技,2011,18(4):306-308., articleTitle=黄芪对肺炎克雷伯菌肺炎大鼠胸腺细胞凋亡及相关基因表达的影响, refAbstract=null), Reference(id=1322923545986211960, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, doi=null, pmid=null, pmcid=null, year=2020, volume=23, issue=6, pageStart=506, pageEnd=509, url=null, language=null, rfNumber=[32], rfOrder=31, authorNames=张雯霞, 陈君灏, 张珏, journalName=实用药物与临床, refType=null, unstructuredReference=张雯霞,陈君灏,张珏. 痰热清注射液对产碳青霉烯酶肺炎克雷伯菌的体外联合杀菌活性研究[J]. 实用药物与临床,2020,23(6):506-509., articleTitle=痰热清注射液对产碳青霉烯酶肺炎克雷伯菌的体外联合杀菌活性研究, refAbstract=null), Reference(id=1322923546053320825, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, doi=null, pmid=null, pmcid=null, year=2021, volume=16, issue=7, pageStart=1290, pageEnd=1294, url=null, language=null, rfNumber=[33], rfOrder=32, authorNames=张晓, 孟琼, 游楚明, journalName=世界中西医结合杂志, refType=null, unstructuredReference=张晓,孟琼,游楚明,等. 桃仁承气汤治疗40例脓毒症患儿的临床疗效及对肠黏膜屏障、TLRs通路的调节作用[J]. 世界中西医结合杂志,2021,16(7):1290-1294., articleTitle=桃仁承气汤治疗40例脓毒症患儿的临床疗效及对肠黏膜屏障、TLRs通路的调节作用, refAbstract=null)], funds=[Fund(id=1322923541557026902, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, awardId=GZY-KJS-2022-105, language=CN, fundingSource=国家中医药管理局中医药科学技术研究专项(GZY-KJS-2022-105), fundOrder=null, country=null), Fund(id=1322923541619941463, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, awardId=T202012, language=CN, fundingSource=无锡市卫生健康委科技成果与适宜技术推广项目(T202012), fundOrder=null, country=null), Fund(id=1322923541708021848, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, awardId=P202005, language=CN, fundingSource=无锡市卫生健康委科普作品创作项目(P202005), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1322923538113503283, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, xref=null, ext=[AuthorCompanyExt(id=1322923538121891892, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, companyId=1322923538113503283, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Wuxi Children's Hospital,Wuxi 214000,Jiangsu,China), AuthorCompanyExt(id=1322923538126086197, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, companyId=1322923538113503283, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=无锡市儿童医院,江苏 无锡 214000)])], figs=null, attaches=null, journal=Journal(id=1255846881855815682, delFlag=0, nameCn=中华中医药学刊, nameEn=Chinese Archives of Traditional Chinese Medicine, nameHistory1=null, nameHistory2=null, issn=1673-7717, eissn=null, cn=21-1546/R, coden=null, periodic=0, language=CN, oaType=null, ccby=null, superviseOffice=null, ownerOffice=null, pubOffice=null, editorOffice=null, officeType=null, aims=null, clcCode=null, officeProv=null, officeCity=null, officeAddr=null, officeZip=null, officeEmail=null, officePhone=null, editDirector=null, officeDirector=null, officeDirectorPhone=null, officeStaffNum=null, officeEmpNum=null, coverPicUrl=v4T+dd+NLAnioIpGAbkcEQ==, journalPrice=null, startedYear=null, abbrevIsoEn=Chinese Archives of Traditional Chinese Medicine, journalRemark=null, publicationField=null, createdTime=1777346829146, updatedTime=1788949222391, createdBy=18614031015, updatedBy=13041195026, firstLetterCn=Z, firstLetterEn=Z, subjectCode=Medical and Pharmaceutical Sciences, subjectName=null, subjectCodeEn=Medical and Pharmaceutical Sciences, subjectNameEn=null, picCn=v4T+dd+NLAnioIpGAbkcEQ==, picEn=RAy5vuC40hwJB+Y0pEARug==, jcr=null, cjcr=null, exts=[JournalExt(id=1304510846391050374, language=CN, name=中华中医药学刊, nameHistory1=null, nameHistory2=null, managedBy=, sponsoredBy=, publishedBy=, editorOffice=, officeProv=null, officeCity=null, officeAddr=, officeZip=, editDirector=, officeDirector=null, officePhone=null, coverPicUrl=null, journalRemark=, submitArticleUrl=null, websiteUrl=, createdTime=1788949222419, updatedTime=1788949222419, createdBy=13041195026, updatedBy=13041195026, submissionGuidelinesUrl=, submissionAuthorUrl=https://zyhs.cbpt.cnki.net/index.aspx?t=1, submissionEditorUrl=https://zyhs.cbpt.cnki.net/index.aspx?t=3, submissionReviewUrl=https://zyhs.cbpt.cnki.net/index.aspx?t=2, submissionCeEditorUrl=, submissionAeEditorUrl=, option={"copyright":""}), JournalExt(id=1304510846449770631, language=EN, name=Chinese Archives of Traditional Chinese Medicine, nameHistory1=null, nameHistory2=null, managedBy=, sponsoredBy=, publishedBy=, editorOffice=, officeProv=null, officeCity=null, officeAddr=, officeZip=, editDirector=, officeDirector=null, officePhone=null, coverPicUrl=null, journalRemark=, submitArticleUrl=null, websiteUrl=, createdTime=1788949222433, updatedTime=1788949222433, createdBy=13041195026, updatedBy=13041195026, submissionGuidelinesUrl=, submissionAuthorUrl=https://zyhs.cbpt.cnki.net/index.aspx?t=1, submissionEditorUrl=https://zyhs.cbpt.cnki.net/index.aspx?t=3, submissionReviewUrl=https://zyhs.cbpt.cnki.net/index.aspx?t=2, submissionCeEditorUrl=, submissionAeEditorUrl=, option={"copyright":""})], databaseList=null, tenantJournalId=1255847919539208197, websiteList=[Website(id=1255847989868900719, webName=null, webTitle=null, webDomain=null, webCopyrigh=null, webIpcNo=null, seoTitle=null, seoKeywords=null, seoDescription=null, tenantJournalId=null, journalId=1255847919539208197, journalNameCn=null, journalNameEn=null, grayFlag=null, tenantId=1146029695717560320, platformId=null, journalGroupId=null, journalGroupNameCn=null, journalGroupNameEn=null, type=1, domain=https://castjournals.cast.org.cn/joweb/zhzyyxk/CN, language=CN, createTime=1777347093312, createBy=18614031015, updateTime=1777347427646, updateBy=18614031015, name=中华中医药学刊-中文, tplId=1146099689490845704, title=中华中医药学刊, delFlag=0, indexPage=/home, props=[WebsiteProps(id=1255849512594170105, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1255847989868900719, code=articleTextType, value=kx, createTime=1777347456358, updateTime=1777347456358, creator=18614031015, updator=18614031015), WebsiteProps(id=1255849512564809974, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1255847989868900719, code=banner, value=null, createTime=1777347456352, updateTime=1777347456352, creator=18614031015, updator=18614031015), WebsiteProps(id=1255849512631918844, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1255847989868900719, code=grayFlag, value=0, createTime=1777347456367, updateTime=1777347456367, creator=18614031015, updator=18614031015), WebsiteProps(id=1255849512552227061, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1255847989868900719, code=logo, value=https://castjournals.cast.org.cn/joweb/zhzyyxk/CN/file/pic?fileId=uitCA2DBwhJaQSiSV07uhw==, createTime=1777347456348, updateTime=1777347456348, creator=18614031015, updator=18614031015), WebsiteProps(id=1255849512657084670, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1255847989868900719, code=minRunFlag, value=0, createTime=1777347456373, updateTime=1777347456373, creator=18614031015, updator=18614031015), WebsiteProps(id=1255849512589975800, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1255847989868900719, code=picServerUrl, value=https://castjournals.cast.org.cn/joweb/zhzyyxk/CN/file/pic, createTime=1777347456357, updateTime=1777347456357, creator=18614031015, updator=18614031015), WebsiteProps(id=1255849512648696061, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1255847989868900719, code=silenceFlag, value=0, createTime=1777347456371, updateTime=1777347456371, creator=18614031015, updator=18614031015), WebsiteProps(id=1255849512581587191, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1255847989868900719, code=staticResourcePath, value=https://castjournals.cast.org.cn/joweb/cast_kjdb_cn_619/, createTime=1777347456355, updateTime=1777347456355, creator=18614031015, updator=18614031015), WebsiteProps(id=1255849512619335930, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1255847989868900719, code=themeColor, value=null, createTime=1777347456364, updateTime=1777347456364, creator=18614031015, updator=18614031015), WebsiteProps(id=1255849512627724539, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1255847989868900719, code=themeStyle, value=null, createTime=1777347456366, updateTime=1777347456366, creator=18614031015, updator=18614031015)]), Website(id=1255847989944398211, webName=null, webTitle=null, webDomain=null, webCopyrigh=null, webIpcNo=null, seoTitle=null, seoKeywords=null, seoDescription=null, tenantJournalId=null, journalId=1255847919539208197, journalNameCn=null, journalNameEn=null, grayFlag=null, tenantId=1146029695717560320, platformId=null, journalGroupId=null, journalGroupNameCn=null, journalGroupNameEn=null, type=1, domain=https://castjournals.cast.org.cn/joweb/zhzyyxk/EN, language=EN, createTime=1777347093330, createBy=18614031015, updateTime=1777347417860, updateBy=18614031015, name=中华中医药学刊-英文, tplId=1146101810881728533, title=Chinese Archives of Traditional Chinese Medicine, delFlag=0, indexPage=/home, props=[WebsiteProps(id=1255849538993119491, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1255847989944398211, code=articleTextType, value=kx, createTime=1777347462652, updateTime=1777347462652, creator=18614031015, updator=18614031015), WebsiteProps(id=1255849538972147968, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1255847989944398211, code=banner, value=null, createTime=1777347462647, updateTime=1777347462647, creator=18614031015, updator=18614031015), WebsiteProps(id=1255849539047645446, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1255847989944398211, code=grayFlag, value=0, createTime=1777347462665, updateTime=1777347462665, creator=18614031015, updator=18614031015), WebsiteProps(id=1255849538930204927, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1255847989944398211, code=logo, value=https://castjournals.cast.org.cn/joweb/zhzyyxk/EN/file/pic?fileId=uitCA2DBwhJaQSiSV07uhw==, createTime=1777347462637, updateTime=1777347462637, creator=18614031015, updator=18614031015), WebsiteProps(id=1255849539064422664, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1255847989944398211, code=minRunFlag, value=0, createTime=1777347462669, updateTime=1777347462669, creator=18614031015, updator=18614031015), WebsiteProps(id=1255849538988925186, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1255847989944398211, code=picServerUrl, value=https://castjournals.cast.org.cn/joweb/zhzyyxk/EN/file/pic, createTime=1777347462651, updateTime=1777347462651, creator=18614031015, updator=18614031015), WebsiteProps(id=1255849539060228359, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1255847989944398211, code=silenceFlag, value=0, createTime=1777347462668, updateTime=1777347462668, creator=18614031015, updator=18614031015), WebsiteProps(id=1255849538980536577, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1255847989944398211, code=staticResourcePath, value=https://castjournals.cast.org.cn/joweb/cast_kjdb_en_623/, createTime=1777347462649, updateTime=1777347462649, creator=18614031015, updator=18614031015), WebsiteProps(id=1255849539001508100, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1255847989944398211, code=themeColor, value=null, createTime=1777347462654, updateTime=1777347462654, creator=18614031015, updator=18614031015), WebsiteProps(id=1255849539039256837, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1255847989944398211, code=themeStyle, value=null, createTime=1777347462663, updateTime=1777347462663, creator=18614031015, updator=18614031015)])], journalTitle=中华中医药学刊, weixinUrl=null, journalUrl=https://castjournals.cast.org.cn/zhzyyxk, iacademicId=null, status=1, seqNo=null, journalTitleEn=Chinese Archives of Traditional Chinese Medicine, journalPhotoCn=v4T+dd+NLAnioIpGAbkcEQ==, journalPhotoEn=RAy5vuC40hwJB+Y0pEARug==, journalFirstLetter=Z, journalRecommend=null, journalNew=null, journalCollection=null, jcrJf=null, cjcrJf=null, jcrJfStr=null, cjcrJfStr=null, submissionFirstDecision=null, sciSubjectClassification=null, casSubjectClassification=null, citeScore=null, totalCitationFrequency=null, icpCode=null, psCode=null, advertisingLicenseCode=null, copyrightInformation=null, country=null, option=, provinceCode=null, provinceName=null, collectFlag=false, interPubPlatform=, interPubPlatformUrl=null), detailUrlCn=https://castjournals.cast.org.cn/joweb/zhzyyxk/CN/10.13193/j.issn.1673-7717.2025.05.007, detailUrlEn=https://castjournals.cast.org.cn/joweb/zhzyyxk/EN/10.13193/j.issn.1673-7717.2025.05.007, pdfUrlCn=https://castjournals.cast.org.cn/joweb/zhzyyxk/CN/PDF/10.13193/j.issn.1673-7717.2025.05.007, pdfUrlEn=https://castjournals.cast.org.cn/joweb/zhzyyxk/EN/PDF/10.13193/j.issn.1673-7717.2025.05.007, aliStartDate=0, aliEndDate=0, collectionFlag=false, citedCount=null, citedUrl=null, previewStatus=0, delFlag=0, hasFullText=1, orderTime=1746806400000, fullTextJson=null, articleText=null, reference=null)
收藏切换
儿童耐碳青霉烯类肺炎克雷伯杆菌脓毒症特点以及中医治疗的研究进展
收藏切换
PDF下载
王燕 , 凌菁菁 , 周丹丽 , 葛焕青
中华中医药学刊 | 国家项目点击 2025,43(5): 32-34
收起
收藏切换
中华中医药学刊 |国家项目点击 2025 , 43 (5) : 32 -34
儿童耐碳青霉烯类肺炎克雷伯杆菌脓毒症特点以及中医治疗的研究进展
全屏
[Author(id=1322923538201583671, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, orderNo=0, firstName=null, middleName=null, lastName=null, nameCn=null, orcid=null, stid=null, country=null, authorPic=null, dead=0, email=null, emailSecond=null, emailThird=null, correspondingAuthor=0, authorType=1, ext={EN=AuthorExt(id=1322923538298052665, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, authorId=1322923538201583671, language=EN, stringName=Yan WANG, firstName=Yan, middleName=null, lastName=WANG, prefix=null, suffix=null, authorComment=null, nameInitials=null, affiliation=null, department=null, xref=null, address=Wuxi Children's Hospital,Wuxi 214000,Jiangsu,China, bio=null, bioImg=null, bioContent=null, aboutCorrespAuthor=null), CN=AuthorExt(id=1322923538356772922, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, authorId=1322923538201583671, language=CN, stringName=王燕, firstName=null, middleName=null, lastName=null, prefix=null, suffix=null, authorComment=null, nameInitials=null, affiliation=null, department=null, xref=null, address=无锡市儿童医院,江苏 无锡 214000, bio={"content":"

王燕(1978-),女,江苏连云港人,主任药师,硕士,研究方向:药事管理、临床药学(儿科)。

"}, bioImg=null, bioContent=

王燕(1978-),女,江苏连云港人,主任药师,硕士,研究方向:药事管理、临床药学(儿科)。

, aboutCorrespAuthor=null)}, companyList=[AuthorCompany(id=1322923538113503283, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, xref=null, ext=[AuthorCompanyExt(id=1322923538121891892, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, companyId=1322923538113503283, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Wuxi Children's Hospital,Wuxi 214000,Jiangsu,China), AuthorCompanyExt(id=1322923538126086197, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, companyId=1322923538113503283, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=无锡市儿童医院,江苏 无锡 214000)])]), Author(id=1322923538423881788, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, orderNo=1, firstName=null, middleName=null, lastName=null, nameCn=null, orcid=null, stid=null, country=null, authorPic=null, dead=0, email=null, emailSecond=null, emailThird=null, correspondingAuthor=0, authorType=1, ext={EN=AuthorExt(id=1322923538490990654, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, authorId=1322923538423881788, language=EN, stringName=Jingjing LING, firstName=Jingjing, middleName=null, lastName=LING, prefix=null, suffix=null, authorComment=null, nameInitials=null, affiliation=null, department=null, xref=null, address=Wuxi Children's Hospital,Wuxi 214000,Jiangsu,China, bio=null, bioImg=null, bioContent=null, aboutCorrespAuthor=null), CN=AuthorExt(id=1322923538558099519, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, authorId=1322923538423881788, language=CN, stringName=凌菁菁, firstName=null, middleName=null, lastName=null, prefix=null, suffix=null, authorComment=null, nameInitials=null, affiliation=null, department=null, xref=null, address=无锡市儿童医院,江苏 无锡 214000, bio=null, bioImg=null, bioContent=null, aboutCorrespAuthor=null)}, companyList=[AuthorCompany(id=1322923538113503283, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, xref=null, ext=[AuthorCompanyExt(id=1322923538121891892, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, companyId=1322923538113503283, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Wuxi Children's Hospital,Wuxi 214000,Jiangsu,China), AuthorCompanyExt(id=1322923538126086197, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, companyId=1322923538113503283, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=无锡市儿童医院,江苏 无锡 214000)])]), Author(id=1322923538629402689, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, orderNo=2, firstName=null, middleName=null, lastName=null, nameCn=null, orcid=null, stid=null, country=null, authorPic=null, dead=0, email=null, emailSecond=null, emailThird=null, correspondingAuthor=0, authorType=1, ext={EN=AuthorExt(id=1322923538696511555, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, authorId=1322923538629402689, language=EN, stringName=Danli ZHOU, firstName=Danli, middleName=null, lastName=ZHOU, prefix=null, suffix=null, authorComment=null, nameInitials=null, affiliation=null, department=null, xref=null, address=Wuxi Children's Hospital,Wuxi 214000,Jiangsu,China, bio=null, bioImg=null, bioContent=null, aboutCorrespAuthor=null), CN=AuthorExt(id=1322923538772009028, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, authorId=1322923538629402689, language=CN, stringName=周丹丽, firstName=null, middleName=null, lastName=null, prefix=null, suffix=null, authorComment=null, nameInitials=null, affiliation=null, department=null, xref=null, address=无锡市儿童医院,江苏 无锡 214000, bio=null, bioImg=null, bioContent=null, aboutCorrespAuthor=null)}, companyList=[AuthorCompany(id=1322923538113503283, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, xref=null, ext=[AuthorCompanyExt(id=1322923538121891892, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, companyId=1322923538113503283, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Wuxi Children's Hospital,Wuxi 214000,Jiangsu,China), AuthorCompanyExt(id=1322923538126086197, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, companyId=1322923538113503283, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=无锡市儿童医院,江苏 无锡 214000)])]), Author(id=1322923538839117894, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, orderNo=3, firstName=null, middleName=null, lastName=null, nameCn=null, orcid=null, stid=null, country=null, authorPic=null, dead=0, email=null, emailSecond=null, emailThird=null, correspondingAuthor=0, authorType=1, ext={EN=AuthorExt(id=1322923538943975496, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, authorId=1322923538839117894, language=EN, stringName=Huanqing GE, firstName=Huanqing, middleName=null, lastName=GE, prefix=null, suffix=null, authorComment=null, nameInitials=null, affiliation=null, department=null, xref=null, address=Wuxi Children's Hospital,Wuxi 214000,Jiangsu,China, bio=null, bioImg=null, bioContent=null, aboutCorrespAuthor=null), CN=AuthorExt(id=1322923539048833097, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, authorId=1322923538839117894, language=CN, stringName=葛焕青, firstName=null, middleName=null, lastName=null, prefix=null, suffix=null, authorComment=null, nameInitials=null, affiliation=null, department=null, xref=null, address=无锡市儿童医院,江苏 无锡 214000, bio=null, bioImg=null, bioContent=null, aboutCorrespAuthor=null)}, companyList=[AuthorCompany(id=1322923538113503283, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, xref=null, ext=[AuthorCompanyExt(id=1322923538121891892, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, companyId=1322923538113503283, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Wuxi Children's Hospital,Wuxi 214000,Jiangsu,China), AuthorCompanyExt(id=1322923538126086197, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923537169784878, companyId=1322923538113503283, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=无锡市儿童医院,江苏 无锡 214000)])])]
王燕, 凌菁菁, 周丹丽, 葛焕青
作者信息
  • 无锡市儿童医院,江苏 无锡 214000
作者简介:

王燕(1978-),女,江苏连云港人,主任药师,硕士,研究方向:药事管理、临床药学(儿科)。

Characteristics of Carbapenem Resistant Klebsiella Pneumoniae Sepsis in Children and Research Progress on Traditional Chinese Medicine Treatment
Yan WANG, Jingjing LING, Danli ZHOU, Huanqing GE
Affiliations
  • Wuxi Children's Hospital,Wuxi 214000,Jiangsu,China
出版时间: 2025-05-10 doi: 10.13193/j.issn.1673-7717.2025.05.007
文章导航
收藏切换

随着近年来抗菌药物的广泛应用,其耐药性不断上升,耐药发展远大于抗菌药物的研发,严重威胁人类生命,加重医疗卫生经济负担。我国儿科病房对耐碳青霉烯类肺炎克雷伯杆菌(Carbapenem resistant Klebsiella pneumoniae,CRKP)检出率不断增长。儿童CRPK脓毒症缺乏特异临床表现,起病隐匿,但致病性强、进展迅速,容易出现多器官衰竭等。碳青霉烯类抗菌药物仍为治疗CRKP感染的主要手段。随着中医对CRKP脓毒症的深入研究,中医药用于CRKP脓毒症方面的治疗越来越受到重视。对儿童耐碳青霉烯类肺炎克雷伯杆菌脓毒症特点以及中医治疗的研究进展作一综述。

儿童耐碳青霉烯类  /  肺炎克雷伯杆菌  /  脓毒症  /  中医  /  研究进展

In recentyears,with thewide application of antibacterial drugs,their drug resistance is rising,and the development of drug resistance is far greater than the development of antibacterial drugs,leading to a serious threat to human life and health and increasing the economic burden ofmedical and health care. The detection rate of carbapenem resistant Klebsiella pneumoniae(CRKP)in pediatric wards in China is increasing. CRPK sepsis in children lacks specific clinicalmanifestations,and its onset is hidden. But it has strong pathogenicity and rapid progression,and is prone tomultiple organ failure. Carbapenem antibiotics are still themainmeans to treat CRKP infection. With the in-depth study of CRKP sepsis in traditional Chinesemedicine,more and more attention has been paid to the treatment of CRKP sepsis with traditional Chinesemedicine. This article aimed to review the characteristics of carbapenem resistant Klebsiella pneumoniae sepsis in children and the research progress of traditional Chinese medicine treatment.

carbapenems resistant children  /  Klebsiella pneumoniae  /  sepsis  /  traditional Chinesemedicine  /  research progress
王燕, 凌菁菁, 周丹丽, 葛焕青. 儿童耐碳青霉烯类肺炎克雷伯杆菌脓毒症特点以及中医治疗的研究进展. 中华中医药学刊, 2025 , 43 (5) : 32 -34 . DOI: 10.13193/j.issn.1673-7717.2025.05.007
Yan WANG, Jingjing LING, Danli ZHOU, Huanqing GE. Characteristics of Carbapenem Resistant Klebsiella Pneumoniae Sepsis in Children and Research Progress on Traditional Chinese Medicine Treatment[J]. Chinese Archives of Traditional Chinese Medicine, 2025 , 43 (5) : 32 -34 . DOI: 10.13193/j.issn.1673-7717.2025.05.007
脓毒症主要是机体对感染的反应失调而造成危及生命的器官功能不全,以微循环紊乱、免疫失调、全身炎症反应综合征及终末器官功能障碍为主要特点[1-4]。随着20世纪40年代初青霉素的出现,掀起了抗菌药物黄金年代,使人类感染的病死率显著下降。但因抗菌药物的不规范使用,导致细菌耐药成为当前的重大公共卫生问题,同时耐药发展远大于抗菌药物的研发,严重威胁人类生命,加重医疗卫生经济负担[5-6]。当前,耐药状况在我国十分严峻,其中头孢菌素耐药大肠埃希菌、耐碳青霉烯类肺炎克雷伯杆菌(Carbapenem resistant Klebsiella pneumoniae,CRKP)、耐甲氧西林凝固酶阴性葡萄球菌及耐甲氧西林金黄色葡萄球菌等是常见的耐药菌,而CRKP的检出率呈逐年增长趋势[7-8]。针对CRKP菌株引起的感染,西医治疗手段有限,并且可供选择抗菌药物极少,故而CRKP感染成为院内感染死亡的一项独立危险因素[9]。随着中医对CRKP的深入研究,认为肺炎克雷伯杆菌是外来之邪气,中医药用于CRKP脓毒症方面的治疗越来越受到重视。基于此,本研究旨在对儿童耐碳青霉烯类肺炎克雷伯杆菌脓毒症特点以及中医治疗的研究进展作一综述。
据1979—2016年流行病学数据统计表明,在全球范围内,在儿童中脓毒症患病为48/100 000,而在新生儿中患病率2022/10 000[10]。目前,脓毒症患病率逐年上升,其中发病率在2006年为92.8/10 000,2012年已增至158.7/100 000。2015年SPROUT研究表明,欧洲地区重症监护病房(Pediatric intensive care unit,PICU)内脓毒症患儿29%,北美地区儿童脓毒症患儿病死率高达21%,新西兰及澳大利亚地区为32%,亚洲地区为40%,南美地区为11%,非洲地区为40%[11]。根据PICU统计显示,中国西南地区8家脓毒症患儿病死率为18.8%[12]。2020年2月提出的《拯救脓毒症运动儿童脓毒性休克和脓毒症相关器官功能障碍国际指南》标准,儿童脓毒症范围为新生儿胎龄≥37周~18岁的青少年[13]。细菌、真菌、病毒及寄生虫等是导致脓毒症的病原体,最常见为细菌性感染[14-16]。碳青霉烯类抗菌药物特点主要为抗菌活性强、抗菌谱广,是多种耐药肠杆菌科细菌感染治疗的最后一道防线[17]。随着临床近年来碳青霉烯类抗菌药物使用增多,导致碳青霉烯类耐药肠杆菌科细菌(Carbapenem resistant Enterobacteriaceae,CRE)不断增多,一项监测研究表明,2008—2013年CHINET监测发现,2008年对碳青霉烯类耐药菌株检出率<1%,2013年升至<7%,并且临床分离的CRE主要为肺炎克雷伯菌[18-19]。同时,CRE感染性疾病发病率和病死率较高,加之由于儿童基础免疫力较低,使CRE更容易感染[20-21]。
目前,关于CRKP对碳青霉烯类抗菌药物耐药机制较多,其表现主要包括以下[22-26]:①产生碳青霉烯酶:是可水解美罗培南或者亚胺培南等碳青霉烯类抗菌药物的β-内酰胺酶,可将其分为A类、B类和D类,其中丝氨酸酶为A类和D类,金属酶为B类,而我国以B类中NDM10型和KPC2型为主。②头孢霉素类:包括质粒介导型和染色体介导型,而其中质粒介导型能够水解头孢菌素类、单酰胺类及三代头孢菌素,并且不受酶抑制剂抑制,以及容易携带多种抗菌药物耐药基因,从而容易引起多重耐药。③产超广谱β-内酰胺酶:主要由质粒介导,可水解几乎所有的单环菌素类和β-内酰胺酶类抗菌药物,能够在菌株间播散和转移。研究报道表明,超过55%的CRKP感染与广谱β-内酰胺酶阳性肺炎克雷伯菌感染引起的死亡相关[27]。④细菌外膜孔蛋白异常表达:当外膜孔蛋白表达缺失或下降时,则会使抗菌药物进入胞体内的速度受到阻碍,以此使有效抑菌浓度受到影响,从而导致耐药。⑤药物作用靶点改变:碳青霉烯类抗菌药物发挥抗菌活性,需与细菌细胞外膜上的青霉素结合蛋白相结合。
脓毒症的发生主要是因微生物侵染后造成人体全身性炎性反应综合征,炎性反应程度和感染程度是导致炎性反应不同程度的重要原因,而肺炎克雷伯菌在儿童脓毒症中占重要作用。肺炎克雷伯菌作为常见的儿童脓毒症一种致病菌,并且是重要的医院感染病原和条件致病菌。常会导致呼吸道感染,也可造成手术部位感染、继发性脑膜炎、泌尿系感染及菌血症等,甚至致死。在儿童尤其是新生儿中,革兰阴性菌脓毒症的临床表现缺乏特异性,通常表现为常见的体温异常、肢端发凉、少动、少哭、少吃等,甚至可发展为休克、多器官衰竭等。近年来,由于经验性和预防性地广泛使用碳青霉烯类抗菌药物和广谱抗菌药物,导致肺炎克雷伯菌对碳青霉烯类抗菌药物耐药率不断上升[28]。特别在儿童中,CRKP感染死亡率高达50%。CRKP感染多由机体免疫功能发育不完善、住院时间长、侵入性操作及病情危重等造成,严重威胁患儿生命[29]。
目前,西医治疗儿童CRPK脓毒症主要包括抗感染、液体复苏和机械通气。(1)抗感染:抗菌药物是治疗儿童CRPK脓毒症的重要方法,在识别脓毒症后1 h内尽快给予抗菌药物注射。但随着抗菌药物的广泛应用,导致其耐药性不断上升,且不良反应较为明显,从而影响治疗效果。(2)液体复苏:针对儿童CRPK脓毒症采取早期有效的液体复苏是治疗的关键措施之一,针对组织灌注不足或血流动力学不稳定的脓毒症患儿,需于6 h内技术化治疗,以达到中心静脉血氧饱和度≥70%、尿量>0.5 mL/(kg·h)、平均动脉压65~90 mm Hg,中心静脉压8~12 mm Hg;该方法的目的主要在于降低死亡率,但该方法在推广应用后关于液体超负荷加重器官衰竭、容量的控制及液体的选择等问题越来越突出,从而影响其治疗效果。(3)机械通气:针对存在急性呼吸窘迫的CRPK脓毒症。当氧合指数<150 mm Hg,临床上推荐俯卧位通气以改善整体通气、提高胸壁顺应性情况,但不推荐应用高频振荡通气;当氧合指数≤200 mm Hg时,临床上推荐采用较高的呼气末正压避免肺泡塌陷。
中医认为正气为本,正气存内,邪不可干,气不足则外邪来扰。古代学者对肺炎克雷伯杆菌无明确的认识,多数医家联系肺炎克雷伯杆菌肺炎,认为是外邪侵犯肺卫,肺气闭郁,肺失宣降,化热,热伤津液,而使肺宣发肃降功能失司,津液无法输布,凝集成痰。中医理论认为,肺主气司呼吸,主一身之气,外合皮毛,通调水道,肺气郁闭出现咯痰、咳嗽、呼吸困难、喘息及发热等症状。五行相生相克,肺属金,肾属水,水生金,肾脏又可受损,肝属木,金克木,故而肺部疾病可累及肝,病情进一步发展,肺部传至其他脏腑,则会导致多脏受损,脏器功能失调。治疗初期临床上应以解表达邪为主,治疗中期临床上应以清热化痰宣肺为主,并且治疗中需注意重视疾病的传变,从而能够做出相应的处理,了解预后。传统医学并无脓毒症概念,临床以发热为主,按照脓毒症临床表现和演变过程,将其归属“热病”范畴。《素问》提出:今夫热病皆伤寒之类也,故而将其又归为“伤寒”范畴。同时,诸多医家认为“内陷”“疔疮”“走黄”“温毒”可归类到脓毒症范畴。脓毒症基本病机是邪之所凑、其气必虚,其发病基础是正虚邪侵。肺为华盖,朝百脉,外邪内侵先范肺,导致肺功能失司,邪气内闭体内,传于营血,出现神昏谵妄等症状。久病入血,瘀血内阻,痰瘀互阻,从而造成脉络不通、脏真受损的一个过程。同时,肺气壅滞,腑气不通,阳明经盛,则毒热内生。
儿童CRKP脓毒症中医辨证分型主要为气虚证,血虚证,阴虚证,阳虚证,血瘀证,毒邪证,热邪证,痰浊证。(1)气虚证:辨证要点为神疲乏力、声低懒言、气短微息、动则加重;(2)血虚证:辨证要点为心悸失眠、头晕眼花、面唇微黄或淡白、舌淡脉细;(3)阳虚证:辨证要点为面色白、形寒肢冷、五更泄泻、大便溏泄、畏寒、夜尿频数、舌淡胖、脉弱无力;(4)阴虚证:辨证要点为虚火上炎、咽干口燥、面白颧赤、手足心热、骨蒸盗汗、舌干红无苔、脉数无力;(5)血瘀证:辨证要点为局部刺痛拒绝按压、面唇舌紫斑瘀点;(6)毒邪证:辨证要点为高热夜重、咳喘气急、口渴烦躁、胸肋满闷、手足蠕动、呕吐阵作、谵语、神昏、出血、舌苔黄燥、脉弦数夜重;(7)热邪证:辨证要点为恶热喜凉、面红耳赤、口渴喜凉饮、痰涕黄稠、烦躁不宁、吐血出血、小便短赤、大便干结、舌红苔黄干燥、脉数;(8)痰浊证:辨证要点为胸腹痞闷、嗜睡、喉中痰鸣、口干不饮、舌苔腻、脉滑。
任鹏等[30]研究表明,产超广谱β-内酰胺酶肺炎克雷伯杆菌应用黄连水煎剂体内、体外抑菌作用发现,黄连水煎剂48 g/L对产酶肺炎克雷伯杆菌在体外抑制作用良好,并与莫西沙星具有协同作用,及在给药7 d可使大鼠感染指标有效降低。雷澍等[31]研究表明,黄芪注射液能够减少肺炎克雷伯杆菌肺炎细胞凋亡,调节凋亡相关基因的表达水平,有利于维持机体正常免疫状态,由此可纠正肺炎克雷伯杆菌引起肺炎时的免疫功能紊乱。杨青美等[27]研究表明,纳入108例肺炎克雷伯菌肺炎患儿,结果显示,中西医结合治疗后总有效率显著高于西医治疗,患儿肺部啰音消失、咳嗽消失、气喘消失、喘鸣音消失时间显著短于西医治疗,且患儿CD3+、CD4+、CD4+/CD8+显著高于西医治疗,而/CD8+显著低于西医治疗,由此可见婴幼儿肺炎克雷伯杆菌肺炎采用中西医结合治疗疗效显著,且患者免疫功能有效改善。张雯霞等[32]研究发现,对产KPC型碳青霉烯酶肺炎克雷伯菌采用痰热清注射液与亚胺培南联合体外杀菌活性,20株产KPC-2型碳青霉烯酶肺炎克雷伯菌对亚胺培南耐药率100%,联合药敏试验55%的菌株对两药组合呈协同作用,而其中的35%菌株呈相加作用,而另外的10%的菌株为无关作用,并且所有菌株联合均未出现拮抗作用,由此可见痰热清注射液与亚胺培南可用于产KPC-2型碳青霉烯酶肺炎克雷伯菌所致感染的治疗。张晓等[33]研究表明,纳入的80例患儿,桃仁承气汤联合常规治疗7 d后,总有效率高于常规治疗,APACHEⅡ评分和SOFA评分显著低于常规治疗,二胺氧化酶、D-乳酸和内毒素水平显著低于常规治疗,高迁移率蛋白B1、白细胞介素-6和肿瘤坏死因子-α水平显著低于常规治疗,Toll样受体2、4和9表达水平显著低于常规治疗,由此可见脓毒症患儿采用桃仁承气汤治疗可显著改善肠黏膜屏障功能,并能够抑制Toll样受体通路介导的炎症反应激活。
我国近年来儿童CRKP脓毒症发病率不断增长,可能与隔离措施不完备、病房空间有限、抗菌药物使用不合理及产前保健宣教不足等因素有关。CRKP致病性强,耐药机制多元化,临床表现隐匿,治疗困难。目前,针对儿童CRKP脓毒症尚无明显有效的抗菌药物,而随着中医药的深入研究用于儿童CRKP脓毒症方面越来越受到重视,不仅可提高疗效,且可减轻不良反应。
  • 国家中医药管理局中医药科学技术研究专项(GZY-KJS-2022-105)
  • 无锡市卫生健康委科技成果与适宜技术推广项目(T202012)
  • 无锡市卫生健康委科普作品创作项目(P202005)
参考文献 引证文献
排序方式:
[1]
GAO Q Z,HERNANDESM S. Sepsis-associated encephalopathy and blood-brain barrier dysfunction[J]. Inflammation,2021,44(6):2143-2150.
[2]
常晨阳,胡绍雯,邓国平,等. 中性粒细胞计数与淋巴细胞和血小板计数比值在儿童脓毒症预后中的预测价值[J]. 实用医学杂志,2023,39(22):2958-2963.
[3]
CHIU C,LEGRAND M. Epidemiology of sepsis and septic shock[J]. Curr Opin Anaesthesiol,2021,34(2):71-76.
[4]
彭智慧,颜海鹏,卢秀兰,等. 补体C3对儿童脓毒症患者预后的预测价值[J]. 中国当代儿科杂志,2023,25(9):941-946.
[5]
魏徐鹏,丁娟娟. 耐碳青霉烯类肺炎克雷伯菌血流感染危险因素分析[J]. 医药论坛杂志,2020,41(4):34-37,41.
[6]
刘长鑫,张侃,王博,等. 血流感染碳青霉烯耐药肺炎克雷伯杆菌的危险因素及预后分析[J]. 解放军医学院学报,2020,41(8):799-804.
[7]
JIN X,CHEN Q,SHEN F,et al. Resistance evolution of hypervirulent carbapenem-resistant Klebsiella pneumoniae ST11 during treatment with tigecycline and polymyxin[J]. Emerg Microbes Infect,2021,10(1):1129-1136.
[8]
龙晓琴. 耐碳青霉烯类肺炎克雷伯杆菌感染的研究进展[J]. 疑难病杂志,2021,20(12):1282-1286.
[9]
RODRIGUESD,BALDISSERA G S,MATHOSD,et al. Amikacin for the treatment of carbapenem-resistant Klebsiella pneumoniae infections:clinical efficacy and toxicity[J]. Braz JMicrobiol,2021,52(4):1913-1919.
[10]
FLEISCHMANN-STRUZEK C,GOLDFARB D M,SCHLATTMANN P,etal. The globalburden of paediatric and neonatal sepsis:a systematic review[J]. Lancet Respir Med,2018,6(3):223-230.
[11]
WEISSSL,FITZGERALD JC,PAPPACHAN J,etal. Global epidemiology of pediatric severe sepsis:the sepsis prevalence,outcomes,and therapiesstudy[J]. Am JRespir Crit Care Med,2015,191(10):1147-1157.
[12]
LU Q,ZHOU M,TU Y,et al. Pathogen and antimicrobial resistance profiles of culture-proven neonatal sepsis in Southwest China,1990-2014[J]. JPaediatr Child Health,2016,52(10):939-943.
[13]
WEISSSL,PETERSM J,ALHAZZANIW,etal. Surviving sepsis campaign international guidelines for themanagementof septic shock and sepsis-associated organ dysfunction in children[J]. Pediatr Crit Care Med,2020,21(2):e52-e106.
[14]
胡语航,任新蕊,徐静,等. 改良qSOFA评分对儿童脓毒症的诊断效能及分诊价值[J]. 中国妇幼健康研究,2023,34(4):104-108.
[15]
项龙,李娟珍,周景艺,等. 新型凝血生物标志物评价儿童脓毒症的临床价值[J]. 中华儿科杂志,2023,61(3):222-227.
[16]
奚悦玲,任宏,张建,等. 儿童脓毒症院内感染相关免疫指标分析[J]. 中华儿科杂志,2021,59(5):368-373.
[17]
刘拥荣,贺立飞,余亚敏,等. 114株耐碳氢酶烯肺炎克雷伯杆菌耐药表型及基因分析[J]. 内科急危重症杂志,2021,27(1):29-32.
[18]
汪复,朱德妹,胡付品,等. 2008年中国CHINET细菌耐药性监测[J]. 中国感染与化疗杂志,2009,9(5):321-329.
[19]
胡付品,朱德妹,汪复,等. 2013年中国CHINET细菌耐药性监测[J]. 中国感染与化疗杂志,2014,14(5):365-374.
[20]
张莉,胡淼,陈媛,等. 耐碳青霉烯类肺炎克雷伯杆菌肺部感染患者不同抗菌药物联合治疗方案的疗效与安全性分析[J]. 药学与临床研究,2022,30(4):315-318.
[21]
陈泗虎,李凯,张胜翔,等. 儿童产ESBLs肺炎克雷伯菌耐药性及基因型研究[J]. 医学研究杂志,2019,48(12):103-107.
[22]
YANG X M,SUN Q L,LI JP,et al. Molecular epidemiology of carbapenem-resistant hypervirulent Klebsiella pneumoniae in China[J]. Emerg Microbes Infect,2022,11(1):841-849.
[23]
安翔宇,谢伟峰,郑旭,等. 青岛市区5家医院耐碳青霉烯类肺炎克雷伯杆菌耐药基因检测及分析[J]. 中华危重病急救医学,2020(2):145-149.
[24]
李珍,朱月钮,许莉莉,等. 多黏菌素治疗小儿重症耐碳青霉烯类革兰阴性菌感染的临床疗效观察[J]. 中国小儿急救医学,2020,27(12):893-898.
[25]
WANG M G,EARLEY M,CHEN L,et al. Clinical outcomes and bacterial characteristics of carbapenem-resistant Klebsiella pneumoniae complex among patients from different global regions(CRACKLE-2):a prospective,multicentre,cohort study[J]. Lancet Infect Dis,2022,22(3):401-412.
[26]
YANG Y Q,YANG Y X,CHEN G P,et al. Molecular characterization of carbapenem-resistant and virulent plasmids in Klebsiella pneumoniae from patients with bloodstream infections in China[J]. Emerg Microbes Infect,2021,10(1):700-709.
[27]
杨青美,谭从容. 中西医结合治疗婴幼儿肺炎克雷伯杆菌肺炎临床疗效观察[J]. 现代中西医结合杂志,2016,25(5):504-506.
[28]
北京地区PICU脓毒症调查协作组. 北京地区两家医院儿科重症监护病房486例脓毒症分析[J]. 中华儿科杂志,2012,50(3):178-183.
[29]
回广飞,马德宾,栾亮,等. 耐碳青霉烯类肺炎克雷伯菌联合给药方案对医院获得性肺炎疗效及安全性分析[J]. 临床军医杂志,2022,50(2):156-159.
[30]
任鹏,潘健,刘志远,等. 黄连水煎剂对产超广谱β内酰胺酶肺炎克雷伯杆菌的抑菌作用[J]. 中国医药,2011,6(2):216-218.
[31]
雷澍,江荣林,朱美飞,等. 黄芪对肺炎克雷伯菌肺炎大鼠胸腺细胞凋亡及相关基因表达的影响[J]. 中国中医药科技,2011,18(4):306-308.
[32]
张雯霞,陈君灏,张珏. 痰热清注射液对产碳青霉烯酶肺炎克雷伯菌的体外联合杀菌活性研究[J]. 实用药物与临床,2020,23(6):506-509.
[33]
张晓,孟琼,游楚明,等. 桃仁承气汤治疗40例脓毒症患儿的临床疗效及对肠黏膜屏障、TLRs通路的调节作用[J]. 世界中西医结合杂志,2021,16(7):1290-1294.
2025年第43卷第5期
PDF下载
28
13
引用本文
BibTeX
文章信息
doi: 10.13193/j.issn.1673-7717.2025.05.007
  • 首发时间:2026-10-30
  • 出版时间:2025-05-10
补充材料
相关文章
文章信息
作者
出版历史
基金
国家中医药管理局中医药科学技术研究专项(GZY-KJS-2022-105)
无锡市卫生健康委科技成果与适宜技术推广项目(T202012)
无锡市卫生健康委科普作品创作项目(P202005)
作者信息
    无锡市儿童医院,江苏 无锡 214000
参考文献
分享链接
https://castjournals.cast.org.cn/joweb/zhzyyxk/CN/10.13193/j.issn.1673-7717.2025.05.007
分享至
全文二维码

扫描看全文

引用本文
BibTeX
本文的引用情况
2种不同金属材料的力学参数
科
Family
属数
Number of
genus
种数
Number of
species
占总种数比例
Percentage of
total species (%)
属
Genus
种数
Number of
species
占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
关闭全屏