儿童白血病化疗后并发败血症的临床分析及治疗  

Theatment and clinical manifestations of septicemia in childhood with leukemia after chemotherapy

作　　者：盛琦[1] 陈同辛[1] 张勤[1] 赵惠君[1] 袁晓军[1] 姚慧玉[1] 

机构地区：[1]上海第二医科大学附属新华医院儿内科.上海市儿童医学中心,200092

出　　处：《中国妇幼保健》2005年第14期1787-1789,共3页Maternal and Child Health Care of China

摘　　要：目的:探讨儿童急性白血病化疗后并发败血症的发生、治疗和预后因素。方法:回顾性分析30例患儿化疗后并发败血症的临床特点。结果:主要病原菌为革兰氏阴性杆菌,其中铜绿假单胞菌最多,其次为大肠埃氏希菌。亚胺培南(泰能)为革兰氏阴性杆菌最敏感抗菌素,万古霉素为革兰氏阳性菌最敏感抗菌素。化疗时中性粒细胞总数持续减低的败血症患儿的病死率高。并发败血症时患儿血清C反应蛋白(CRP)的水平明显升高。结论:革兰氏阴性杆菌为儿童急性白血病化疗后并发败血症的最常见病原菌。中性粒细胞减低的持续时间与败血症的发生与预后有密切关系。临床上遇到可疑的败血症患儿应尽早查血培养和CRP,同时给予经验性抗感染治疗。亚胺培南为儿童急性白血病化疗后粒细胞减少并发严重感染时十分有效的抗生素。Objective:To explore the treatment and prognosis of septicemia in children with leukemia after chemotherapy.Methods:To review clinical manifestations of 30 patients with septicemia after chemotherapy.Results:Gram-negative bacillus was the leading organism. Among them Pseudomonas aeruginosa was the primary cause, and Escherichia coli was the second. Imipenem was the most sensitive drug against gram-negative bacillus, while vancomycin being the most sensitive one against gram-positive cocci. The mortality of patients whose absolute neutrophil count(ANC) had been continuously at low level was the highest. CRP level increased significantly during septicemia.Conclusion:Gram-negative bacillus was the most common pathogen of septicemia in children with leukemia after chemotherapy. The occurrence and prognosis of the septicemia were associated with the duration of neutropenia. Blood culture and CRP should be examined in patients supposed to have septicemia clinically, and the experienced antibiotics should be used promptly. Imipenem was an effective antibiotics to children with septicemia in childhood leukemia with neutropenia.

关 键 词：儿童急性白血病 败血症 治疗 

分 类 号：R725.5[医药卫生—儿科]