摘要
目的:分析初治急性髓系白血病患者诱导化疗后粒细胞缺乏伴发热的感染特点,并探讨抗感染治疗策略。方法:回顾分析我院2014年1月至2016年11月我院60例初治急性髓系白血病患者化疗后粒细胞缺乏伴发热医院感染部位、病原菌特点及抗菌药物应用情况。结果:能够明确感染部位42例(占70.00%),不能明确感染部位者18例(占30.00%),前三位常见的感染部位是呼吸道(占45.24%)、血液(占14.29%)及肛周(占9.52%);病原菌检出36株,革兰阴性杆菌占58.33%,革兰阳性球菌占30.56%,真菌占11.11%。降阶梯治疗组的有效率高于升阶梯治疗组,病死率低于升阶梯治疗组,发热持续时间短于升阶梯治疗组(均P<0.05)。结论:急性髓系白血病患者初次诱导化疗后粒细胞缺乏伴发热感染部位以呼吸道为主,感染部位不明确患者占有较高比例;病原菌以革兰阴性杆菌为主;升阶梯治疗可能延误抗感染时机,延长感染控制时间及增加感染相关病死率,亚胺培南为基础的降阶梯抗感染治疗能够取得满意疗效。
Objective： To analyze the infection characteristics in initially treated patients with acute myeloid leukemia（ AML） complicated with agranulocytosis and fever following chemotherapy,and to explore the strategy of anThe infected site,pathogen characteristics and the application of antibiotics in 60 AML cases wehospital from January 2014 to November 2016. Results： The infected sites were clearly identified in 42 cases（70. 00not identified in 18 cases （ 30. 00% ）, and the top three infected sites were respiratory tract （45. 24% ）,blood （ 14. 29% ） and crissum （ 9. 52% ） ; 36 pathogenic bacteria were detected, gram negative bacilli accounted for 58. 33%, gram positive cocci accounted for 30. 56%,and fungi accounted for 11. 11%. The effective rate was higher,the caof fever in top-down（ de-escalation） treatment group was shorter than those in step-up treatment group（ all !〈0. 05）. Conclusion： In AML patients with agranulocytosis and fever after first induction chemotherapy,the infected site is mainly respiratory tract.Those with unclear infected site have a high proportion. Gramnegativv bacilli are the main painfection control time and increase infection-related case fatality. However, imipenem based top-down anti-infectioobtain satisfactory curative effect.
出处
《现代临床医学》
2018年第1期53-55,共3页
Journal of Modern Clinical Medicine
关键词
急性髓系白血病
粒细胞缺乏
发热
感染
降阶梯治疗
acute myeloid leukemia
agranulocytosis
fever
infection
top-down （ de-escalation） therapy
作者简介
通信作者：杨福冬,569975808@qq.com
