儿童恶性肿瘤化疗后中性粒细胞减少并发脓毒症的早期识别  

Early identification of sepsis in cancer children with neutropenia after chemotherapy

作　　者：杨燕文[1] 王莹[1] 汤静燕[1] 李璧如[1] 

机构地区：[1]上海交通大学医学院附属上海儿童医学中心,200127

出　　处：《中国小儿急救医学》2012年第4期383-386,共4页Chinese Pediatric Emergency Medicine

摘　　要：目的本研究通过对恶性肿瘤儿童化疗后粒细胞减少症并发发热时早期临床征象进行研究，探寻其和脓毒症发病的关系。方法以恶性肿瘤化疗后粒细胞减少症并发发热的66例患儿为研究对象，进行前瞻性观察性研究。根据病情进展，将66例患儿分为脓毒症组26例，非脓毒症组40例。收集并比较两组患儿的临床资料和实验室指标。结果脓毒症组和非脓毒症组患儿的初始体温、粒细胞减少天数、中性粒细胞绝对计数（absoluteneutrophiccount，ANC）、血清C反应蛋白水平、降钙素原水平和培养阳性率比较，差异有统计学意义（P〈0．05）。当体温〉40℃、ANC〈0．1×109／L、C反应蛋白升高、降钙素原升高、培养阳性提示可能并发脓毒症。体温〈39℃、粒细胞减少〈5d、ANC〉0．5×109／L提示并发脓毒症可能性很小。结论初始体温高、粒细胞减少天数长、ANC严重减少、C反应蛋白及降钙素原升高和培养阳性与恶性肿瘤儿童并发脓毒症相关。Objective To investigate the clinical manifestations of the febrile neutropenia cancer children,explore the relationship between the clinical data and sepsis. Methods A prospective observation study was employed, and 66 cancer children complicated with febrile and neutropenia after chemotherapy were enrolled. Sixty-six cases were divided into two groups ： septic group （ n = 26 ） and non-septic group （ n = 40 ）. Clinical and laboratory data were collected and compared. Results Body temperature, neutropenia dura- tion, absolute neutrophic count （ANC）, C-reactive protein （CRP）, procalcitonin （PCT） and culture positive rate showed statistically differences between the septic and non-septic groups （ P 〈 0. 05 ）. Body temperature 〉40 ℃ ,ANC 〈 0. 1 × 109/L, increases of serum CRP and PCT levels and positive culture were correlated with sepsis. Body temperature 〈 39 ℃, neutropenia duration 〈 5 ds, ANC 〉 0. 5 × 109/L were less correlated with sepsis. Conclusion High initial temperature, long duration of neutropenia, severely reduced ANC, increases of CRP and PCT, and culture-positive are correlated with sepsis in cancer children.

关 键 词：脓毒症 恶性肿瘤 中性粒细胞减少症 儿童 

分 类 号：R730.5[医药卫生—肿瘤]