小儿危重白血病合并休克47例临床回顾分析

A clinical study on leukemia with shock in children-a four retrospection

目的 分析儿科ICU(PICU)白血病休克病例的发生特点和转归。方法 对 47例合并休克患儿进行回顾性分析 ,并对 7例患儿测定了血浆肿瘤坏死因子 (TNF -α)、白介素 - 6 (IL - 6 )、IL - 10。结果 47例患儿占同期PICU内休克病例的 2 0 .8% ,死亡 32例 ,病死率 6 8.1%。起始休克类型 :感染性休克 18例、低血容量性休克 8例、中毒性休克 3例、“神经 -心源性休克”6例、“混合性休克”12例。休克前均存在多脏器损害 ,感染、药物细胞毒性是重要诱发因素。所测TNF -α、IL - 10均明显增高。血培养阳性率 5 8.9%。结论 本组均符合亚急性 -复杂型休克特点及预后。对脏器低灌注和失控炎症 -免疫反应的监测可能有助于防止和早期发现休克。

Objective To analyze the characteristics and prognosis of leukemia with shock in PICU.Methods 47 leukemia patients with shock admitted from 1996 to 1999 were analyzed retrospe,inively. The TNF-α、IL-6,IL-10 levels in blood were measured in 7patients. Results 47 shock occured 20.8% of mortality.32 cases died,accounted-for 68.1% of mortality. The types of the shock at start were 28 cases of septic shock, 8 of hypovolumic shock, 3 of toxic shock, 6 of neurologic-cardiac shock and 12 of hypovolumic shock, 3 of toxic shock, 6 of neurologic-cardiac shock and 12 of mixed shock. All patients have multiple organ dysfunction.And the sepsis and drugs cytotoxicity were main precipatating events.The concentrations of TNF-α、IL-6,IL-10 increased significantly.Conclusion All cases showed the characteristics and prognosis of the subacute complicated shock. Monitoring organ hypoperfusion and uncontroled in flammatory-immunology response may be of helpful to prevention and early recognition of shock.