急性白血病并发败血症的临床分析

发布时间：2018-08-13 13:35

【摘要】：目的：探讨急性白血病并发败血症发生率的影响因素及病原学，为急性白血病并发败血症的预防及抗生素选择提供有价值的参考，降低急性白血病并发败血症的病死率。方法：回顾性研究了我院2010年1月至2013年1月血液内科收治的68例次急性白血病并发败血症患者的临床资料，了解急性白血病并发败血症发病率的影响因素，常见原发感染部位，并分析药敏结果。结果：1.影响因素：性别、年龄对急性白血病并发败血症的发生率无影响；急性淋巴细胞白血病较急性非淋巴细胞白血病败血症发生率高，其中急性淋巴细胞白血病发生率为10.63%，急性非淋巴细胞白血病败血症发生率为6.51%，二者差异经统计P=0.047，有统计学意义；中性粒细胞绝对值、血浆白蛋白水平越低，败血症的发生率越高；免疫抑制剂、糖皮质激素治疗及深静脉置管应用为影响败血症发生率的重要因素。2.感染部位：急性白血病并发败血症患者原发感染部位以呼吸道感染最为常见（占54.4%），其次是肠道（占13.2%）及肛周感染（占10.4%）。3.感染细菌及药敏：革兰氏阴性菌感染率最高，共47例次，占总病原菌的69.1%，以大肠埃希氏菌为主，共26例次，占总病原菌的38.2%；革兰氏阳性菌中金黄色葡萄球菌及人葡萄球菌人亚种感染率最高，均为5例次，均占总病原菌7.4%；革兰氏阴性菌对亚胺培南敏感率最高（为97.8%）；革兰氏阳性菌对万古霉素敏感率最高（为100%）。4.45株革兰氏阴性菌中ESBLs阳性菌株为30株，阳性率为66.7%，其中17株为应用三代头孢后感染，13株未应用三代头孢感染。结论：本研究急性白血病并发68例次败血症患者分析及统计结果得出如下结论： 1.急淋败血症的发生率较急非淋患者高；与糖皮质激素及免疫抑制剂使用、粒细胞缺乏、深静脉置管及低血浆白蛋白有关，与年龄无关。2.发生败血症患者原发感染灶最常见呼吸道感染，其次是肠道及肛周感染。3.败血症以革兰氏阴性细菌感染为主，最常见大肠埃希氏菌；合理应用抗生素是改善急性白血病并发败血症患者预后的重要因素；尽量避免经验性应用三代头孢，，降低产超广谱β酰胺酶耐药菌感染率。
[Abstract]:Objective: to explore the influencing factors and etiology of acute leukemia complicated with septicemia, to provide valuable reference for the prevention of acute leukemia complicated with septicemia and the choice of antibiotics, and to reduce the mortality rate of acute leukemia complicated with septicemia. Methods: the clinical data of 68 patients with acute leukemia complicated with septicemia were studied retrospectively from January 2010 to January 2013, and the factors influencing the incidence of acute leukemia complicated with septicemia were investigated. The common site of primary infection and the results of drug sensitivity were analyzed. The result is 1: 1. Influencing factors: sex and age had no effect on the incidence of septicemia in acute leukemia, and acute lymphoblastic leukemia had a higher incidence of septicemia than acute non-lymphocytic leukemia. The incidence of acute lymphoblastic leukemia was 10.63 and that of acute non-lymphocytic leukemia was 6.51. The difference between the two was statistically significant (P = 0.047). The absolute value of neutrophil and the level of plasma albumin were lower. Immunosuppressive agents, glucocorticoid therapy and deep vein catheterization were important factors affecting the incidence of sepsis. Infection site: respiratory tract infection was the most common site (54.4%), intestinal tract infection (13.2%) and perianal infection (10.4%) were the most common infection sites in patients with acute leukemia complicated with septicemia. The infection rate of Gram-negative bacteria was the highest, accounting for 69.1% of the total pathogenic bacteria, 26 cases were Escherichia coli, accounting for 38.2% of the total pathogenic bacteria. Among Gram-positive bacteria, the infection rate of Staphylococcus aureus and human staphylococcus human subspecies was the highest (5 cases), accounting for 7.4% of the total pathogenic bacteria, and Gram-negative bacteria was the most sensitive to imipenem (97.8%). The susceptibility rate of Gram-positive bacteria to vancomycin was the highest (100%). Among the gram-negative strains, 30 were ESBLs positive strains, and the positive rate was 66.7. Among them, 17 strains were infected after the third generation of cefosporin infection and 13 strains were not infected with the third generation of cephalosporins. Conclusion: the analysis and statistical results of 68 cases of acute leukemia complicated with septicemia are as follows: 1. The incidence of acute septicemia was higher than that of patients with acute and non-lymphoid leukemia, and was related to glucocorticoid and immunosuppressive agents, granulocyte deficiency, deep vein catheterization and low plasma albumin, but not related to age. Primary infection was the most common respiratory tract infection in septicemia patients, followed by intestinal and perianal infection. 3. Septicemia is mainly caused by Gram-negative bacterial infection, the most common bacteria is Escherichia coli. Rational use of antibiotics is an important factor to improve the prognosis of patients with acute leukemia complicated with septicemia. To reduce the infection rate of extended-spectrum 尾 -amine resistant bacteria.
【学位授予单位】：遵义医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R733.71;R515.3

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