急性淋巴细胞白血病患儿首次诱导缓解化疗合并肠梗阻的临床分析

Clinical analysis of children acute lymphoblastic leukemia during induced remission chemotherapy with intestinal obstruction

目的探讨儿童急性淋巴细胞白血病(ALL)首次VDLP诱导缓解化疗合并肠梗阻的发生情况、影响因素。方法收集2009年5月-2017年3月在安徽医科大学第二附属医院儿科住院并完成首次诱导缓解化疗的新发ALL患儿共246例,比较合并肠梗阻组与非肠梗阻组患儿的感染发生情况、伊曲康唑使用情况,并进行卡方检验及相关性分析,讨论肠梗阻发生的影响因素。结果246例ALL中,合并肠梗阻者共43例(17.48%),其中39例梗阻前1周内合并感染并静脉使用广谱抗菌药,有34例使用伊曲康唑口服液预防真菌感染;未合并肠梗阻者共203例,其中合并感染者133例,有89例采用伊曲康唑口服液预防真菌感染,经统计学分析,梗阻前合并感染及应用伊曲康唑与肠梗阻发生存在相关性(P<0.05)。结论 VDLP方案化疗期间,合并感染组的肠梗阻发生率(22.67%)高于非感染组(5.41%),如需应用预防性抗真菌治疗,因伊曲康唑口服液可增加肠梗阻发生风险,应尽量避免使用。

Objective To analyze the relationship between children acute lymphoblastic leukemia and intestinal obstruction. Methods A retrospective study was carried out in 246 children with acute lymphoblastic leukemia（ALL） from May 2009 to March 2017, who admitted in the department of pediatrics in the second hospital of anhui medical university, completed the first induced chemotherapy, compared with groups of children infected with the intestinal obstruction group, use of itraconazole, the difference of what is happening,and use chi-square test and correlation analysis, discuss the influence factors of intestinal obstruction occurred.Results Among 246 cases of ALL,43（17.48%） were accopanied with intestinal obstruction, 39 cases of obstruction merge infection and intravenous broad-spectrum antimicrobials within one week before intestinal obstruction occurred, and there were 34 cases using itraconazole oral liquid to prevent fungal infection;Unincorporated a total of 203 cases of intestinal obstruction, which merge infection in 133 cases, 89 cases with itraconazole oral liquid to prevent fungal infection, after statistics analysis, before the obstruction, infection and application of itraconazole correlation with intestinal obstruction（P 0. 05）. Conclusions During VDLP chemotherapy, the incidence of intestinal obstruction in infeciton group（22.67%） was more than the uninfection group（5.41%）, for application of antifungal prophylaxis, should try to avoid using itraconazole oral liquid because it can increase the incidence of intestinal obstruchion.