儿童急性髓性白血病强烈化疗粒细胞缺乏期预防性应用抗生素临床疗效研究  

Clinical study of prophylactic antibiotics in neutropenic children after intensive chemotherapy for childhood acute myeloid leukemia

作　　者：阮永胜[1] 李春富[1] 何岳林[1] 张玉明[1] 冯晓勤[1] 

机构地区：[1]南方医科大学南方医院儿科,广东广州510515

出　　处：《中国实用儿科杂志》2013年第8期594-597,共4页Chinese Journal of Practical Pediatrics

摘　　要：目的探讨儿童急性髓性白血病(AML)强烈化疗粒细胞缺乏(以下简称粒缺)期采用预防性应用抗生素的临床疗效,以期减少细菌性感染发生率,降低感染相关病死率。方法回顾性分析2011年1月至2012年2月在南方医科大学南方医院儿科住院治疗的22例儿童AML强烈化疗共76疗程中感染性发热的发生情况,其中预防组在粒缺时给予万古霉素联合头孢吡肟,或单用哌拉西林/三唑巴坦预防细菌感染,观察30疗程;未予预防性应用抗生素的46疗程为对照组。比较两组感染发生率及平均住院天数等指标。结果预防组中12疗程发生感染性发热(40.0%),对照组中41疗程发生(89.1%),且感染相关死亡1例,两组比较差异有统计学意义(P<0.05)。预防组平均住院天数为(21.93±4.93)d,对照组为(29.17±12.96)d(P<0.05)。使用抗生素预防期间未见抗生素相关的严重毒副反应。结论对儿童AML强烈化疗粒缺期预防性应用抗生素能有效降低感染性发热发生率,缩短平均住院时间,使患儿受益。Objective To decrease the incidence of bacterial infection and mortality of infection by prophylactic antibiot- ics in neutropenic children after intensive chemotherapy for childhood acute myeloid leukemia. Methods Infective fe- brile events were retrospectively analyzed in 22 childhood acute myeloid leukemia patients who underwent 76 intensive chemotherapy courses from Jan.2011 to Feb 2012. In prophylaxis group （30 courses） , vancomycin combined with ce- fepime or Piperacillin/Tazobactam lonely was used as prophylaxis at the onset of neutropenia. In controlled group （46 courses）, patients had no antibiotics until febrile events occurred. SPSS software 13.0 version was used to analyze the significances of incidences of febrile and mean hospitalization days in prophylaxis group and control group by the chi-square test and student t-test. Results The incidence of infective febrile was 12 （40.0%）and 41 （89.1%）in the prophylaxis group and controlled group respectively （P〈 0.05）. One patient died from infection in control group. The mean hospitalization days were （21.93± 4.93）days and （29.17 ± 12.96）days in the prophylaxis group and controlled group respectively, P 〈 0.05. No severe side effects related to antibiotics were observed. Conclusion Prophylactic anti- biotics can effectively reduce the incidence of infective febrile and shortened hospitalization days in neutropenic children after intensive chemotherapy for childhood acute myeloid leukemia. Childhood acute myeloid leukemia patients can bene- fit from prophylactic antibiotics in our clinical study.

关 键 词：急性髓性白血病 预防 抗生素 粒细胞缺乏 发热 

分 类 号：R72[医药卫生—儿科]