造血干细胞移植患者移植早期肛周感染的影响因素

Risk factors for perianal infection in the early stage of hematopoietic stem cell transplantation

目的分析苏州市某三甲医院血液科移植中心造血干细胞移植早期患者肛周感染的高危因素,提出预防措施,降低感染的发生率。方法选择2018年6月-2019年9月行造血干细胞移植患者627例,分为肛周感染组和非感染组,对诊断、移植类型、预处理方案及性别、年龄、文化程度,肛周既往病史,移植前、后排便形态及肛周局部状态,以及卫生习惯等危险因素进行分析。结果造血干细胞移植患者移植类型、预处理方案和预处理方案中加入ATG,与移植早期肛周感染发生率之间差异有统计学意义(P<0.05)。患者的肛周既往史(内痔、感染史)、移植前肛周状态、移植期排便形态(腹泻)、患者卫生习惯、肛周局部清洁状态、女病人月经天数,与移植早期肛周感染发生率之间差异有统计学意义(P<0.05)。结论通过对高危因素的预防性护理,避免物理、化学刺激,提高局部清洁度,增加皮肤黏膜的保护,维持其完整性,特别需要重视在患者血液病治疗初期给予有效的干预措施与宣教,预防肛周疾患,养成良好的卫生习惯,但重中之重是降低腹泻发生率,才能有效降低造血干细胞移植早期患者肛周感染的发生。

OBJECTIVE To analyze the high-risk factors for perianal infection in patients in the early stage of hematopoietic stem cell transplantation in a tertiary hospital in Suzhou,and to propose preventive interventions to reduce the incidence of infection.METHODS A total of 627 patients who underwent hematopoietic stem cell transplantation during Jun 2018 and Sep 2019 were recruited.They were divided into two groups depending on whether perianal infections occurred.Factors included the diagnosis,transplant type,pretreatment plan,perianal medical history,pre-and-post-transplantation morphology and local perianal conditions of the patients were evaluated.Patients′gender,age,education level and hygienic habits were also taken into considered.RESULTS The result demonstrated that patients′transplant types,the pretreatment plan and ATG adding in the pretreatment plan,perianal medical history(internal hemorrhoids,history of infection),the perianal state before transplantation,defecation shape during transplantation(diarrhea),hygienic habits of patients,local cleanliness of perianal area,menstrual days of female patients were significantly related with the incidence of perianal infection in early transplantation(P<0.05).CONCLUSION Efforts should be made to carry out interventions in the early stage of treatment.Preventive care for high-risk factors should be carried out to avoid the physical and chemical stimulus,improve local cleanliness,protect the skin and mucous membrane.But most of all,reducing the incidence of diarrhea is the key point to reduce the incidence of perianal infection.