236例白血病患者合并感染的相关危险因素分析(1)
摘要：目的：研究白血病患者感染的特点及相关危险因素，降低感染死亡率。方法：选取2016年1月-2018年1月甘肃省人民医院收治的236例白血病患者作为研究对象，采用回顾性研究方法，收集患者临床资料，分析其感染的特点及相关危险因素。结果：236例白血病患者中，发生感染179例，感染率为75.84%，其中医院感染112例，感染率47.46%，社区感染67例，感染率28.38%。以呼吸道感染为主，上呼吸道88例，占49.16%，下呼吸道67例，占37.43 %。共送检标本208次，以血液和痰标本多见。发生医院感染的112例患者中，共检出病原菌19株，革兰阴性菌12株，占63.16%，以大肠埃希菌多见，革兰阳性菌6株，占31.58%，真菌1株，占5.26%。单因素分析发生医院感染的相关危险因素，结果提示患者化疗、粒细胞缺乏、使用糖皮质激素、血红蛋白及血小板计数是感染的危险因素，进一步多因素分析显示使用糖皮质激素是感染的独立危险因素。结论：白血病患者化疗、化疗后出现粒细胞缺乏、使用糖皮质激及血红蛋白、血小板计数减低时，患者感染几率增加，呼吸道是主要感染部位，需积极预防。
关键词：白血病;医院感染;感染部位;病原菌;影响因素
【中图分类号】 【文献标识码】A 【文章编号】1004-7484(2019)10-0204-03
Risk factors associated with infection in leukemia Patients
【Abstract】Objective： To study the characteristics and risk factors of infection in leukemia Patients and to reduce the mortality rate of infection. Methods： 236 cases of leukemia Patients admitted to our hosPital from January 2016 to January 2018 were selected as the research objects. The clinical data of the Patients were collected by retrosPective study， and the characteristics of infection and related risk factors were analyzed. Results： Of 236 Patients with leukemia， 179 had infection， the infection rate was 75.84%. Among them， 112 had nosocomial infection， 47.76% had community infection， and the infection rate was 28.38%. ResPiratory tract infection was the main cause， with 88cases of uPPer resPiratory tract (49.16%) and 67 cases of lower resPiratory tract (37.43%). Among 112 Patients with nosocomial infection， 19 strains of Pathogenic bacteria were detected， 12 strains of Gram-negative bacteria (63.16%). Escherichia coli was the most common Pathogen， 6 strains of Gram-Positive bacteria (31.58%) and 1 strain of fungi (5.26%). Univariate analysis showed that chemotheraPy， agranulocytosis， glucocorticoid use， hemoglobin and Platelet count were risk factors for nosocomial infection. Further multivariate analysis showed that glucocorticoid use was an indePendent risk factor for infection. Conclusion： When leukemia patients suffer from agranulocytosis， glucocorticoid stimulation， hemoglobin and platelet counts decrease after chemotherapy， the infection rate increases. Respiratory tract is the main infection site， which should be prevented actively.
【key words】Leukemia; Nosocomial infection; Infection site; Pathogens; Influencing factors
白血病是一種骨髓造血干祖细胞的恶性克隆性疾病，是目前最常见的血液系统恶性肿瘤之一。目前随着新型化疗药物的出现及化疗方案的不断优化，白血病患者的生存率明显提高，但是由此导致的不良反应也越来越多，其中以感染最多见。由于疾病本身、化疗药物的骨髓抑制及使用免疫抑制剂等因素的影响使得白血病患者的免疫功能显著降低，感染风险增加[1]。有报道发现医院感染是影响白血病患者生存的主要因素之一，因此在白血病患者的诊疗中，应早期识别，早期诊断并掌握白血病患者医院感染的常见部位及主要菌群，给予积极预防及治疗，对降低感染死亡率至关重要。本研究主要探讨236例白血病患者感染的临床特点及相关危险因素，现报告如下。, http://www.100md.com(张玉霞 张启科 李青芬 魏小芳 冯友繁)
关键词：白血病;医院感染;感染部位;病原菌;影响因素
【中图分类号】 【文献标识码】A 【文章编号】1004-7484(2019)10-0204-03
Risk factors associated with infection in leukemia Patients
【Abstract】Objective： To study the characteristics and risk factors of infection in leukemia Patients and to reduce the mortality rate of infection. Methods： 236 cases of leukemia Patients admitted to our hosPital from January 2016 to January 2018 were selected as the research objects. The clinical data of the Patients were collected by retrosPective study， and the characteristics of infection and related risk factors were analyzed. Results： Of 236 Patients with leukemia， 179 had infection， the infection rate was 75.84%. Among them， 112 had nosocomial infection， 47.76% had community infection， and the infection rate was 28.38%. ResPiratory tract infection was the main cause， with 88cases of uPPer resPiratory tract (49.16%) and 67 cases of lower resPiratory tract (37.43%). Among 112 Patients with nosocomial infection， 19 strains of Pathogenic bacteria were detected， 12 strains of Gram-negative bacteria (63.16%). Escherichia coli was the most common Pathogen， 6 strains of Gram-Positive bacteria (31.58%) and 1 strain of fungi (5.26%). Univariate analysis showed that chemotheraPy， agranulocytosis， glucocorticoid use， hemoglobin and Platelet count were risk factors for nosocomial infection. Further multivariate analysis showed that glucocorticoid use was an indePendent risk factor for infection. Conclusion： When leukemia patients suffer from agranulocytosis， glucocorticoid stimulation， hemoglobin and platelet counts decrease after chemotherapy， the infection rate increases. Respiratory tract is the main infection site， which should be prevented actively.
【key words】Leukemia; Nosocomial infection; Infection site; Pathogens; Influencing factors
白血病是一種骨髓造血干祖细胞的恶性克隆性疾病，是目前最常见的血液系统恶性肿瘤之一。目前随着新型化疗药物的出现及化疗方案的不断优化，白血病患者的生存率明显提高，但是由此导致的不良反应也越来越多，其中以感染最多见。由于疾病本身、化疗药物的骨髓抑制及使用免疫抑制剂等因素的影响使得白血病患者的免疫功能显著降低，感染风险增加[1]。有报道发现医院感染是影响白血病患者生存的主要因素之一，因此在白血病患者的诊疗中，应早期识别，早期诊断并掌握白血病患者医院感染的常见部位及主要菌群，给予积极预防及治疗，对降低感染死亡率至关重要。本研究主要探讨236例白血病患者感染的临床特点及相关危险因素，现报告如下。, http://www.100md.com(张玉霞 张启科 李青芬 魏小芳 冯友繁)
参见：首页 > 医疗版 > 疾病专题 > 血液内科 > 白血病