127例白血病大剂量化疗后骨髓抑制期感染的处理

Treatment of 127 cases with acute leukemia during bone marrow suppression after high-dose chemotherapy

目的探讨急性白血病大剂量化疗后骨髓抑制程度与医院感染的关系及治疗措施。方法对血液内科127例急性白血病患者住院化疗后的医院感染发生及治疗情况进行回顾性分析。结果大剂量化疗后医院感染率高达78.45%,多发生于大剂量化疗后2周内,骨髓重度抑制及中性粒细胞计数<1.0×109/L时医院感染率明显高于骨髓轻中度抑制和中性粒细胞计数>1.0×109/L的患者,医院感染菌株以革兰阴性杆菌最常见。结论急性白血病患者大剂量化疗后骨髓抑制和中性粒细胞计数明显降低是医院感染主要易感因素,抗生素加粒细胞集落刺激因子合理应用,能减少医院感染发生率及严重程度。

Objective To discuss the relation between bone marrow suppression and nosocomial infection after high-dose chemotherapy of acute leukemia cases and treatment measures. Methods Nosocomial infection clinical data and treatment of 127 acute leukemia cases treated by chemotherapy were summarized retrospectively. Results Nosocomial infection rates was 78.45% after 2 weeks by high-dose chemotherapy. Nosocomial infection rates of cases for neutrophil count less than 1.0xl09/L were more than that of cases for neutrophil more 1.0 × 10^9/ L and bone marrow suppression degree. Conclusion Bone marrow suppression degree and less than neutrophil count of acute leukemia patients is main risk factor of infection after high-dose chemotherapy. The rational use of antibiotics and granulocyte colony-stimulating factor could reduce the incidence and degree of hospital infection.