白血病患儿化疗后合并感染状况的分析

Analysis of infections in leukemia children when going on with chemotherapy

目的探讨白血病化疗后合并感染的相关危险因素。方法回顾性调查中南大学湘雅医院儿科1998￣2003年收治的464例,640例次白血病患儿在化疗后的感染情况,包括感染日期、感染部位、发热持续时间、白细胞数、病原体、化疗阶段和抗生素使用情况及其相互关系。结果在640例次化疗病例中,共有272例次发生感染。其中,急淋患儿感染率高于急非淋患儿;最常见的感染部位是呼吸道,感染的绝大多数病原菌为革兰氏阴性菌;在化疗阶段中,诱导缓解阶段易发生感染;白细胞数越低,感染率越高,发热持续时间越长;同时,预防性使用抗生素种类越多,感染几率越大。对于已感染患儿,使用抗生素加辅助治疗比单独使用抗生素者发热持续时间短。结论感染为白血病患儿在化疗后的主要合并症,易发生在诱导缓解阶段,尤其是粒细胞减少期,应加强对这部分患儿的管理;对白血病患儿化疗中预防性使用抗生素应慎重,注意合理用药。

[Objective] To explore the risk factors associated with infections in leukemia children with chemotherapy. [Methods] An retrospective investigation was made on 640 leukemia children of Pediatrics Department of Xiang Ya Hospital from 1998 to 2003. The investigation included the date, the locus, the duration of fever, the pathogens, the phrase of chemotherapy, the count of leucocyte and the use of antibiotic drugs. [Results] Among the 640 patients, there were 272 patients got infections during chemotherapy. All of the children were liable to be gotten infections than those of ANLL; the most common infectious location was respiratory tract; the most frequent pathogen was gram-negative bacteria, and infections often occurred in the remisson stage of therapy. The low leucocyte cells were related to the high rate of infection and the long time of fever..At the same time, prophylactic using antibiotic had relation to the high rate of infections. [Conclusions] Infection may be one of the main complications of children leukemia during chemotherapy, especially in the stage of remisson. We should pay more attention to the children who are of granulocytopenia. It is advisable to use antibiotics prudently.