急性白血病并发感染性休克18例临床分析  

Clinical analysis of 18 children with acute leukemia complicated with septic shock.

作　　者：张碧红[1] 付茹婷[1] 薛红漫[1] 陈纯[1] 

机构地区：[1]中山大学孙逸仙纪念医院儿科,广东广州510120

出　　处：《中国实用儿科杂志》2013年第6期436-438,共3页Chinese Journal of Practical Pediatrics

基　　金：广东省自然科学基金自由申请项目(编号:S2011010002648);广东省科技计划项目(编号:2011B050400023)

摘　　要：目的探讨儿童急性白血病并发感染性休克的危险因素、临床特点及预后。方法回顾中山大学孙逸仙纪念医院2005-01-01—2012-06-01发生感染性休克的18例急性白血病患儿的临床资料,分析感染性休克临床特点、治疗措施、效果及死亡高危因素等。结果男性患儿15例(83.3%),平均发病年龄9.8岁,平均强化疗疗程6.5次。全部患儿中性粒细胞计数<0.5×109/L,低白蛋白血症13例(13/15,86.7%),心功能不全12例(66.7%),肺炎13例(72.2%),多器官功能障碍(MODS)7例(38.9%)。病原体培养革兰阴性(G-)菌9例,其中铜绿假单胞菌3例,革兰阳性(G+)菌2例,均为溶血性葡萄球菌。18例患儿中1例放弃治疗,6例死亡,11例治愈,病死率35.3%。单因素分析结果显示,休克纠正组与死亡组在发热24h内使用敏感抗生素、休克抢救过程中出现MODS两方面的差异有统计学意义(P<0.05),休克时是否合并肺炎、心功能不全、是否为复发难治患者差异无统计学意义。结论大龄男童、粒细胞缺乏、多次化疗、低白蛋白血症是发生感染性休克的高危因素。病原菌以G-菌多见,尤以铜绿假单胞菌居多,溶血性葡萄球菌不容忽视。患儿并发心功能不全多见,但肌酸激酶同工酶(CK-MB)不增高或增高不明显。发热24h内未使用敏感抗生素、MODS是导致死亡的高危因素。尽早使用敏感抗生素,给予积极的器官功能支持,是降低感染性休克患儿死亡的重要措施。Objective To investigate the related factors, clinical features and prognosis of septic shock in children with acute leukemia. Methods Analyse the clinical features, therapeutic measures, effect and death risk factors of eighteen children with acute leukemia and septic shock in our hospital from Jan.l, 2005 to Jun.1,2012. Result Male children 15 cases （83.3%）, with a mean onset age of 9.8 years, the average strong chemotherapy treatment of 6.5 times. All children＇ s neutrophile granulocyte count was lower than 0.5 × 10^9/ L, hypoalbuminemia occurred in 13 cases （13/15, 86.7%）, cardiac dysfunction in 12 cases （66.7%）, pneumonia in 13 cases （72.2%）, MODS in 7 cases （38.9%）. Bacterial culture was gram negative （G-） bacillus in 9 cases, including pseudomonas aeruginosa（3 cases） ;gram positive （G ＋） bacteria in 2 cases, both were hemolytic staphylococcus. Among the 18 cases, 1 gave up treatment, 6 cases died, 11 cases were cured, and the mortality rate was 35.3%. Single factor analysis results showed that the use of sensitive antibiotics within 24 hours during fever in the shock-correction group and the death group had statistical significances, as well as the occurrence of MODS in the process of shock rescue （P 〈 0.05）.Shock merger pneumonia, cardiac dysfunction, and refractory-relapsed patients had no statistical significance. Conclusion The older boys, agranulocytosis, multiple chemotherapy and hypoalbuminemia are high risk factors of septic shock. Gram negative bacilli is more in bacte- rial culture, especially pseudomonas aeruginosa.Staphylococcus heamolyticus can＇t be ignored. Patients with cardiac dysfunction are common, but CK - MB doesn＇t increase or increase obviously, Not using sensitive antibiotics within 24 hours since fever occurs and MODS are the high-risk factors causing death. Using sensitive antibiotics as soon as possible and supportting the organ function actively are important measures to reduce the death of children with septic shock.

关 键 词：感染性休克 儿童 白血病 脑钠肽 

分 类 号：R72[医药卫生—儿科]