恶性肿瘤化疗后致粒细胞缺乏32例疗效分析

The Clinical Analysis of Agranulocytosis Caused by Chemotherapy for Malignant Tumors in 32 cases

目的探讨恶性肿瘤化疗致粒细胞缺乏的处理措施及疗效。方法 32例恶性肿瘤患者常规剂量化疗,确定粒细胞缺乏后,立即采取消毒隔离措施,给予重组人粒细胞集落刺激因子(rhG-CSF)直至粒细胞升至正常范围。常规应用免疫调节剂。发热患者常规使用第3代头孢菌素,根据病原学检测及药敏试验结果调整治疗。合并贫血(血红蛋白<80 g/L)者输注去白红细胞悬液,食欲差者给予静脉营养支持等。结果 32例患者经综合治疗,29例恢复正常,恢复时间为4～15 d,平均为8 d,有效率为90.6%(29/32),3例患者因原发病未控及感染等原因死亡,病死率为9.4%(3/32)。15例发生感染,感染率为43.8%(14/32)。结论恶性肿瘤化疗致粒细胞缺乏,感染发生率较高,应用rhG-CSF疗效确切,综合治疗可降低病死率。

Objective To explore effects and treatment measures of agranulocytosis caused by chemotherapy for malignant tumors.Methods 32 patients were given chemotherapy with regular dose,after agranulocytosis was determined by the blood tests,they were disinfected and isolated immediately and given rhG-CSF subcutaneous injection,twice each day until the index returned to the normal range.Immunomodulator was applied as routine measure.The patients who got fever were given the third-generation cephalosporins,which was adjusted according to etiological detection and drug susceptibility testing.Patients with anemia（hemoglobin80 g/L） were given infusion of RBC suspension（white cell excluded）,and patients with poor appetite were given intravenous nutritional support.Results Among the 32 patients who were given comprehensive treatment,29 recovered to normal after 4-15 days,8 days on average,and the efficiency rate was 90.6%（29/32）,3 patients died because of primary diseases out of control or infection,the death rate was 9.4%（3/32）.15 of the patients were infected,the infection rate was 43.8%（14/32）.Conclusion The chemotherapy for malignant tumors can lead to agranulocytosis and increased infection rate,and rhG-CSF has affirmative therapeutic effect while comprehensive treatment can reduce mortality.