105例血液病患者院内感染分析

Analysis of hospital infections for 105 patients with blood diseases

目的 :探讨血液病患者院内感染的相关因素及处理。方法 :采用回顾性调查方法 ,对 10 5例院内感染的血液病患者进行调查分析。结果 :10 5例病人共发生 136例次院内感染。其中 87例次 (6 4% )发生在中性粒细胞绝对值 (ANC)低于1× 10 9/ L 时。感染部位以呼吸系统和口腔为主。病原菌以革兰阴性杆菌、革兰阳性球菌和真菌多见。细菌大多对青霉素、氨苄青霉素和庆大霉素耐药。院内感染开始出现轻微症状时即用氨苄青霉素的疗效显著大于感染症状明显时再用氨苄青霉素的疗效 ,表明院内感染早用抗生素疗效好。结论 :血液病患者易受院内感染的主要因素是 ANC减少。当 ANC小于 1× 10 9/L时 ,应对病人进行保护性隔离 ,及时发现感染及使用恰当抗生素 ,注意清除病灶及引流脓液 ,并加强支持治疗。

Objective: To study the risk factors and treatment of hospital infections for patients with blood diseases. Methods: Using retrospective study method to analyse the risk factors and treatment of hospital infections on 105 patients with blood diseases. Results: 136 person-times of hospital infections happened among 105 cases. The major infective positions situated on respiratory system and oral cavity. The major infective bacteria were gram-negative bacillus, gram-opsitive micrococcus and fungi. Most of bacteria have a relatively higher rate of drug resistance to penicillin, ampicillin and gentamycin. The main risk factor of hospital infections was the absolute neutrocyte(ANC) decline. The cure rate of the group using antibiotics in the early stage (57.1%) is higher than that in the late stage(38.5%). Meanwhile the infective recur rate of the group ceasing antibiotics after ANC recover was lower(6.7%) than that before ANC recover(26.8%). Transfusing WBC to patients of non-chemotherapy group helped controlling the infections better than that of the chemotherapy group. Conclusions: Protective isolating the patients with a low ANC(<1×10\+9/L),discovery of the hospital infections and an adequate usage of antibiotics in the early stage till the temperature and ANC recover were all important to reduce the hospital infective rates. \ \