小儿急性白血病合并医院感染的特点和危险因素分析

Analysis of the Dangerous Factors and the Features of Infantile Acute Leukemia Connected with Hospital Infection

目的 :探讨小儿急性白血病 (acute leukemia,AL)合并医院感染的特点、危险因素、防治措施。方法 :回顾性调查在本院儿科住院的 AL患儿共 10 8例。结果 :3 5例、4 6例次发生医院内感染 ,感染率 3 2 .4 1% ,例次感染率 4 2 .5 9% ,感染直接引起死亡 12例 (11.11% ) ,以呼吸道感染为主 ,并发症常见且严重。致病菌以 G- 杆菌为主。粒细胞减少特别是≤ 1.0× 10 9/ L、住院时间超过 12周、诱导化疗阶段医院感染率较粒细胞数 >1.0× 10 9/ L、住院时间 <12周、巩固、强化治疗阶段明显升高。这与患儿年龄、白血病类型无相关性。结论 :AL患儿易发生医院内感染 ,病死率高 ,致病菌以G- 杆菌为主 ,粒细胞减少特别是≤ 1.0× 10 9/ L、住院时间超过 12周、诱导化疗阶段是医院内感染的危险因素 ,应加强监测和预防 。

Objective: To research into the clinical features,dangerous factors,prevention and cure measures of infantile acute leukemia (AL) connected with hospital infection. Methods:108 cases of infantile AL from September of 1992 to September of 2002 were investigated and analyzed.Results: There were 35 cases, 46 times hospital infection in the investigation.The infection rate was 32 41% while rate of times reached 42 59%. The hospital infection directly resulted in 12 cases of death (11 11%), most of which were respiratory infection Meanwhile,complication was common and serious.The pathogenic bacteria were mainly G - bacilli. Comparing with people in consolidating and strengthening treatment period with over 1 0×10 9/Lgranulocyte number, and who had been hospitalized for less than twelve weeks, the patients whose granulocyte number decreases, especially to be or below 1 0×10 9/L, who had also been hospitalized for more than twelve weeks and in revulsive treatment period, suffered from high hospital infection rate,which had nothing to do with the age of patient and AL type. Conclusion: Infantile AL patients are apt to catch hospital infection, and the mortality is high. The pathogenic bacteria are mainly G - bacilli. The dangerous factors of hospital infection are as follow: granulocyte number decreases, especially to be or below 1 0×10 9/L,who have also been hospitalized for more than twelve weeks and in revulsive treatment period. Therefore, we should pay great attention to watch and precaution, apply the antibiotic which is sensitive to pathogenic bacteria, as well as strengthen supporting treatment.