發(fā)布時間：2018-04-05 09:19

  本文選題：兒童　切入點：急性白血病　出處：《寧夏醫(yī)科大學》2017年碩士論文

【摘要】：背景急性白血病(AL)是兒童時期發(fā)病率最高的惡性腫瘤,隨著醫(yī)療水平的不斷提高,AL的生存率和緩解率得到很大提高。然而新的化療方案較之前相比,化療療程更長、強度更大,化療藥物在殺死腫瘤細胞的同時,也引起了包括骨髓抑制在內(nèi)的多種并發(fā)癥,隨之而來的便是感染。骨髓抑制時感染早期,臨床感染表現(xiàn)不明顯,發(fā)熱可能是其唯一的表現(xiàn)形式。如何在發(fā)熱早期明確致病病原,對早期臨床經(jīng)驗性治療有參考意義。目的對我院兒童急性白血病化療后出現(xiàn)骨髓抑制發(fā)熱時進行病原分析,通過了解本組AL患兒化療骨髓抑制期發(fā)熱原因及病原學分布,對遠期臨床用藥提供參考,通過危險因素的分析,對其早期干預。方法選取2015年12月至2016年12月在寧夏醫(yī)科大學附屬總院兒科診斷明確且化療的AL患兒51例,且在化療期間或化療后進入骨髓抑制期累計361例次,出現(xiàn)發(fā)熱累計217例次,除一些藥物反應(yīng)外,其余所有患兒出現(xiàn)發(fā)熱時,均需在抗生素使用前留取血或骨髓培養(yǎng)、血清降鈣素原(PCT)測定、C反應(yīng)蛋白(CRP),感染性發(fā)熱患兒留取相應(yīng)的的病原學標本。對所有發(fā)熱例次的相應(yīng)發(fā)熱原因及對病原學進行統(tǒng)計。對發(fā)熱相關(guān)危險因素,如年齡、性別、骨髓抑制程度(中性粒細胞減少程度)進行分析。結(jié)果1、本研究中AL化療骨髓抑制期發(fā)熱率為60%,發(fā)熱原因以上、下呼吸感染(發(fā)熱率為41.5%)最常見,其次為粒細胞減少性發(fā)熱(Febrile neutropenia,FN)4.5%,胃腸道感染(4.2%),敗血癥(2.0%)。2、共檢出病原36株,病原學檢出率為19.3%。3、發(fā)熱與骨髓抑制程度、年齡有關(guān),與性別無關(guān)。結(jié)論1.AL化療引起的骨髓抑制,發(fā)熱率高達60%,其中非感染性發(fā)熱占11.2%,感染性發(fā)熱占88.8%,骨髓抑制發(fā)熱時感染危險性高。2.AL化療引起骨髓抑制時發(fā)熱的原因中主要以呼吸道感染為主,其次為中性粒細胞減少性發(fā)熱、胃腸道感染、敗血癥及藥物反應(yīng)。3.AL化療引起骨髓抑制發(fā)熱時,病原學檢出率較低,為19.3%,其中細菌感染占80.1%,以G-菌為主,為52.8%,G+菌27.8%。4.AL化療引起骨髓抑制期發(fā)熱相關(guān)風險中,骨髓抑制程度和發(fā)熱有密切關(guān)系,骨髓抑制程度越重,發(fā)熱率越高。5.AL化療引起骨髓抑制時,骨髓抑制程度和感染指標陽性率有關(guān),骨髓抑制程度越重,其感染指標陽性率越高,10例診斷為敗血癥的患兒中PCT值明顯增高,且在感染性發(fā)熱中陽性率較高。
[Abstract]:Background Acute Leukemia (ALL) is a malignant tumor with the highest incidence in childhood. The survival rate and remission rate of AL have been greatly improved with the improvement of medical treatment.However, the new chemotherapy regimen is longer and more intensive than before. Chemotherapy drugs not only kill tumor cells, but also cause many complications, including bone marrow suppression, followed by infection.In the early stage of myelosuppression infection, clinical infection is not obvious, fever may be its only manifestation.How to identify the pathogeny in the early stage of fever has reference significance for early clinical experience therapy.Objective to analyze the pathogenesis of bone marrow suppression fever after chemotherapy in children with acute leukemia in our hospital, and to find out the causes and etiological distribution of bone marrow suppression fever after chemotherapy in this group of AL children, so as to provide a reference for long-term clinical use.Early intervention was carried out through the analysis of risk factors.Methods from December 2015 to December 2016, 51 children with AL diagnosed in pediatrics of affiliated General Hospital of Ningxia Medical University were diagnosed and treated with chemotherapy, and 361 patients entered the period of bone marrow suppression during chemotherapy or after chemotherapy, and 217 cases had fever.Except for some drug reactions, blood or bone marrow culture should be taken before antibiotics were used in all the children with fever. Serum procalcitonin (PCT) was used to determine the C-reactive protein (CRP).The causes of fever and etiology of all fever cases were analyzed.Risk factors associated with fever, such as age, sex, and bone marrow suppression (neutropenia), were analyzed.緇撴灉1,鏈爺絀朵腑AL鍖栫枟楠ㄩ珦鎶戝埗鏈熷彂鐑巼涓，

本文編號：1714143