恶性血液病合并败血症的临床分析

Clinical analysis of malignant hematological disease combined with septicemia

目的 研究恶性血液病合并败血症的临床特点、病原菌、药敏情况及防治措施.方法 回顾性分析2009年1月至2013年6月收治的95例恶性血液病合并败血症患者的临床资料.结果 95例患者一共发生110例次败血症,69.1％（76/110）为急性白血病患者,82.7％（91/110）患者中性粒细胞计数＜ 0.5×109/L,66.4％（73/110）患者粒细胞缺乏时间＞7d,致病菌以革兰阴性菌为主,主要为大肠埃希菌（30.9％,34/110）、肺炎克雷伯杆菌（14.5％,16/110）、铜绿假单胞菌（12.7％,14/110）.药敏以碳青霉烯类及阿米卡星最为敏感,经治疗110例次败血症中有98例次治愈或好转,95例患者中12例死亡,病死率12.6％（12/95）,其中15例发生感染性休克的患者,7例死亡.结论 恶性血液病合并败血症病情重,进展迅速,容易发生感染性休克,病死率高,需对患者进行早期防治,并进行强有力的抗感染及积极支持治疗.

Objective To study the clinical characteristics,pathogens,drug sensitivity and prevention measures in malignant hematological disease combined with septicemia.Methods The clinical data of 95 malignant hematological disease combined with septicemia patients from January 2009 to June 2013 were retrospectively analyzed.Results One hundred and ten episodes of septicemia occurred in all the 95 patients,among which acute leukemia patients accounted for 69.1% （76/110）,patients with neutrophil counts 〈0.5 × 109/L accounted for 82.7% （91/110）,and patients with agranulocytosis time 〉7 days accounted for 66.4%（73/110）.Major pathogenic bacteria was gram negative bacteria,including Escherichia coli 30.9%（34/110）,Klebsiella pneumoniae （14.5%,16/110）,Pseudomonas aeruginosa （12.7%,14/110）.Carbapenems and amikacin was the most sensitive in susceptibility testing.Ninety-eight episodes of septicemia cured or improved,and 12 patients died,with a mortality of 12.6% （12/95）.Fifteen patients had septic shock,of whom 7 patients were dead.Conclusions Septicemia is very serious for malignant hematological patients,which may lead to rapidly progress,high incidence to septic shock and high mortality.Early prevention and treatment is important for patients,and strong anti-infection and supportive treatment is needed.