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儿童造血干细胞移植相关毛细血管渗漏综合征3例分析并文献复习 被引量:5

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摘要 目的探讨造血干细胞移植( HSCT)相关毛细血管渗漏综合征( CLS)的发病机制及临床表现、诊断标准、治疗原则、预后情况,以提高临床医生对此病的认识。方法分析3例儿童异基因造血干细胞移植( allo-HSCT)相关CLS患者的诱因、发病情况、诊断、治疗、预后等情况。结果该研究中移植相关CLS发病率为6.38%,其发生多与预处理过程中大剂量化疗、全身放疗及某些药物的使用导致内皮细胞损伤有关。3例移植相关CLS均发生于移植预处理过程中,以体重增加、全身浮肿为初发表现,后出现严重水肿及低血压,甚至休克,均伴肝功能和胆红素异常、白蛋白快速下降。1例为顽固性低血压,1例血压升高,1例血压下降但纠正后很快维持平稳;2例存在肺水肿;2例存在脏器水肿(腹腔、心包);1例进展为肾功能不全;3例均存在血液浓缩表现。在监测中心静脉压( CVP)及体重变化、维持电解质平衡的基础上进行补液,以补充胶体液为主,维持各脏器血流灌注。经以上治疗后1例因顽固性低血压伴多脏器衰竭死亡,1例予适当减低预处理强度后好转,1例病情很快控制并较好耐受预处理,顺利完成造血干细胞移植全过程。结论 HSCT相关CLS发生的早期是可逆的,早诊断、早治疗是决定CLS疗效和预后的关键。
出处 《国际儿科学杂志》 2014年第4期450-454,共5页 International Journal of Pediatrics
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