重症血液病患儿血流感染的临床分析  

Analysis of bloodstream infection in children with severe hematopathy

作　　者：张家源 陈玉梅 邹尧 张丽 阮敏 陈晓娟 刘晓明 竺晓凡 

机构地区：[1]中国医学科学院血液病医院儿童血液病诊疗中心,天津300020

出　　处：《中华医院感染学杂志》2014年第20期5136-5138,共3页Chinese Journal of Nosocomiology

基　　金：国家自然科学基金资助项目(81200396);协和青年科研基金资助项目(2012j17);科技部重大专项基金资助项目(2011ZX09302-007);国家重大科学研究计划基金资助项目(2012CB966603)

摘　　要：目的探讨重症血液病患儿治疗过程中发生血流感染的原因、感染部位、病原菌分析及治疗对策。方法选择2007年1月-2009年9月住院治疗的血液病患儿2 368例,对血液病患儿血流感染的发生率、感染部位与病原菌分布及相关因素进行分析,数据采用SPSS16.0统计软件进行处理,样本率的比较采用χ2检验。结果 2 368例住院治疗患儿中167例患儿发生血流感染,发生率7.1%;其中发生血流感染的急性淋巴细胞白血病患儿95例、急性髓性白血病患儿61例、重型再生障碍性贫血患儿9例、恶性淋巴瘤患儿2例,分别占56.9%、36.5%、5.4%、1.2%;感染部位以口腔黏膜与呼吸道为主,分别占12.6%与10.2%;经血培养检测,共分离出病原菌167株,其中革兰阴性杆菌90株占53.9%,革兰阳性球菌71株占42.5%,革兰阳性杆菌、真菌各3株,各占1.8%;急性淋巴细胞白血病患儿中应用糖皮质激素>2周及中性粒细胞绝对值<100/mm3与血流感染高度相关。结论急性髓性白血病较急性淋巴细胞白血病患儿易发生血流感染,血液病患儿中性粒细胞绝对值<100/mm3与血流感染的发生高度相关。OBJECTIVE To explore the causes ,sites and pathogens of bloodstream infection in children with severe hematopathy and the method to decrease the mortality of bloodstream infection .METHODS Totally 2368 children with hematopathy were selected .The incidence rate ,infected sites ,pathogen distribution and related factors for bloodstream infection in children with hematopathy were analyzed . Data were processed by SPSS16 .0 , the comparison of sample rate was conducted with χ2 test .RESULTS There were 167 cases of bloodstream infection in the 2368 hospitalized children ,indicating the incidence was 7 .1% .The children who experienced bloodstream infection included 95 children with acute lymphoblastic leukemia ,61 children with acute myeloid leukemia ,9 children with severe aplastic anemia and 2 children with malignant lymphoma ,accounting for 56 .9% ,36 .5% , 5 .4% and 1 .2% .The infected sites were mainly oral mucosa and respiratory tract ,accounting for 12 .6% and 10 .2% .The blood culture detected 167 pathogens ,including 90 gram-negative bacilli （53 .9% ） ,71 gram positive coccus （42 .5% ） ,3 gram positive bacilli （1 .8% ） and 3 fungi （1 .8% ） .The incidence of bloodstream infection was highly related to glucocorticoid use 〉 2 weeks and the absolute level of neutrophils 〈100/mm^3 in children with acute lymphoblastic leukemia .CONCLUSION The incidence rate of bloodstream infection in the patients with acute myeloid leukemia was higher than that in acute lymphoblastic leukemia .The absolute level of neutrophils 〈100/mm3 was highly related to bloodstream infection in children with hematopathy .

关 键 词：血液病 患儿 血流感染 危险因素 治疗 

分 类 号：R181.32[医药卫生—流行病学]