儿童急性白血病合并脓毒症69例分析  

Analysis of 69 septicemia cases with acute leukemia after chemotherapy

作　　者：于皎乐[1] 张永红[1] 吴敏媛[1] 石慧文[1] 谢静[1] 王彬[1] 吴润辉[1] 

机构地区：[1]首都医科大学附属北京儿童医院血液病中心,100045

出　　处：《中国小儿血液与肿瘤杂志》2008年第3期117-120,共4页Journal of China Pediatric Blood and Cancer

摘　　要：目的探讨儿童白血病治疗中出现脓毒症(败血症)的原因及治疗对策。方法对白血病患儿化疗后出现血培养阳性的病原学、临床表现、相关因素、治疗方法与疗效进行分析。结果824例白血病患儿全身炎症反应综合征的总发生率为13.6%(69/824)。确诊脓毒症8.37(69/824)。结论急性淋巴细胞白血病化疗中脓毒症的好发阶段是诱导缓解及再诱导缓解阶段;病原菌以革兰氏阴性杆菌多见。常见的感染途径是消化道与呼吸道。脓毒症的发生与粒细胞绝对值负相关,与粒细胞缺乏,持续时间及化疗强度呈正相关。早期对粒细胞缺乏伴发热的治疗可降低脓毒症的并发症及死亡率。Objective To explore the cause of septicemia in pediatric acute leukemia patients after chemotherapy and the method to decrease the mortality of septicemia. Methods Sixty-nine leukemia patients suffered from septicemia in total 824 cases enrolled from Jan. of 2002 to Dec. of 2006 were analyzed. Results The morbidity of patients with septicemia was high in introduction and reintroduction chemotherapy course. The infection size included respiratory tract, gastrointestinal tract and oral membrane. Gram-negative bacilli were still the common pathogenic bacteria including Escherichia coli and pseudomonas aeruginosa. The risk factors of septicemia were the strength of chemotherapy, level of granulocyte and duration of agranulocytosis. Conclusion In patients with acute leukemia, the incidence of septicemia was related to the strength of chemotherapy, level of granulocyte and duration of agranulocytosis. Respiratory tract and gastrointestinal tract were the common positions of infection. Gram-negative bacilli were more common in clinical. It is suggested that leukemia patients who are complicated with neutropenic fever should be treated immediately in order to reduce the mortality of septicemia.

关 键 词：白血病 儿童 败血症 危险因素 治疗 

分 类 号：R733.7[医药卫生—肿瘤]