本文選題：急性淋巴細(xì)胞白血病 + 血小板輸注��； 參考：《中國(guó)循證兒科雜志》2017年01期

【摘要】：目的探討急性淋巴細(xì)胞白血病(ALL)患兒血小板輸注的療效及其影響因素。方法納入2013年1月1日至2016年6月30日在中南大學(xué)湘雅三醫(yī)院血液科及兒科就診的全部初診、初治,且在治療過(guò)程中至少輸注1次單采血小板的、14歲的ALL患兒。單采血小板的輸注采用ABO、Rh同型輸注策略。每例每次輸注血小板后同時(shí)滿足24 h校正血小板增加指數(shù)(CCI)4.5和24 h血小板回收率(PPR)20%,且消化道、鼻和牙齦出血癥狀得到控制,判定為當(dāng)次輸注有效,否則為當(dāng)次輸注無(wú)效。有效例次歸為有效組,無(wú)效例次歸為無(wú)效組。對(duì)可能影響血小板輸注療效的因素(年齡、性別、發(fā)熱、出血、脾大、感染、是否使用頭孢菌素、血小板輸注次數(shù))行單因素和多因素分析。結(jié)果 44例ALL患兒進(jìn)入本文分析,共輸注單采血小板302例次,有效組197例次(65.2%),無(wú)效組105例次,每例患兒平均輸注(6.1±5.6)次。302例次中;輸注血小板前后的血小板計(jì)數(shù)(×10~9·L~(-1))分別為19.2±9.4和66.1±36.2,差異有統(tǒng)計(jì)學(xué)意義(t=11.19,P0.01);輸注1次(44例次)、~5次(93例次)、~10次(67例次)和10次(98例次)的輸注有效率分別為84.1%、76.3%、56.7%和52.0%。單因素分析顯示,有效組和無(wú)效組比較,發(fā)熱、出血、脾大、感染和血小板輸注次數(shù)差異有統(tǒng)計(jì)學(xué)意義,P均0.05。Logistic多因素回歸分析顯示,發(fā)熱(OR=3.737,95%CI:1.213~11.513)和感染(OR=3.258;95%CI:1.019~10.419)是影響血小板輸注療效的主要危險(xiǎn)因素。結(jié)論血小板輸注可以改善ALL患兒的血小板計(jì)數(shù)及出血癥狀,發(fā)熱和感染為影響ALL患兒血小板輸注療效的主要危險(xiǎn)因素。
[Abstract]:Objective to investigate the effect of platelet transfusion in children with acute lymphoblastic leukemia (ALL) and its influencing factors. Methods from January 1, 2013 to June 30, 2016, all the patients with ALL, aged 14 years, who were first diagnosed in the Department of Hematology and Pediatrics, Xiangya third Hospital, Central South University, and who received at least one transfusion of platelets during the course of treatment, were enrolled in the study. The single platelets were infused with the same type of ABO Rh infusion strategy. After each transfusion of platelets, 24 h adjusted platelet increase index (CCI) 4.5 and 24 h platelet recovery rate (PPR-20) were satisfied. The bleeding symptoms of digestive tract, nose and gingival were controlled, which was determined to be effective for the second infusion, otherwise it would not be effective for the current infusion. Valid cases are classified as valid group and invalid cases as invalid group. Univariate and multivariate analysis was performed on factors (age, sex, fever, bleeding, splenomegaly, infection, use of cephalosporins and platelet transfusion times) that might affect the efficacy of platelet transfusion. Results 44 cases of ALL were analyzed in this paper. A total of 302 cases of platelets were infused, 197 cases of effective group were treated with 65.2times, 105 cases of ineffective group were given, the average infusion time of each child was 6.1 鹵5.6 times. The platelet count (脳 109L ~ (-1) before and after transfusion was 19.2 鹵9.4 and 66.1 鹵36.2, respectively. The difference was statistically significant (P < 0.01); the effective rate of infusion was 84.1L 76.3i% and 52.0%, respectively. The effective rate of transfusion was 84.1L 76.3AD 56.7% and 52.075%, respectively, and that of 44 cases (44 cases) was 95 times (67 cases) and 98 times (10 times). The effective rates of platelet count before and after transfusion were 84.1 鹵9.4 and 66.1 鹵36.2respectively, and the effective rates were 52.0% and 52.0%, respectively. Univariate analysis showed that there were significant differences in fever, hemorrhage, splenomegaly, infection and platelet transfusion between the effective group and the ineffective group by 0.05.Logistic multivariate regression analysis. The main risk factors affecting the efficacy of platelet transfusion were fever 3.737 / 95 CI: 1.213 (11.513) and infection (3.25895 CI: 1.019 10.419). Conclusion Platelet transfusion can improve platelet count and bleeding symptoms in children with ALL. Fever and infection are the main risk factors affecting the efficacy of platelet transfusion in ALL children.
【作者單位】： 中南大學(xué)湘雅三醫(yī)院輸血科;
【分類號(hào)】：R457.1;R733.71

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