【摘要】：目的：探討急性白血病并發(fā)敗血癥發(fā)生率的影響因素及病原學(xué)，為急性白血病并發(fā)敗血癥的預(yù)防及抗生素選擇提供有價(jià)值的參考，降低急性白血病并發(fā)敗血癥的病死率。 方法：回顧性研究了我院2010年1月至2013年1月血液內(nèi)科收治的68例次急性白血病并發(fā)敗血癥患者的臨床資料，了解急性白血病并發(fā)敗血癥發(fā)病率的影響因素，常見原發(fā)感染部位，并分析藥敏結(jié)果。 結(jié)果：1.影響因素：性別、年齡對(duì)急性白血病并發(fā)敗血癥的發(fā)生率無影響；急性淋巴細(xì)胞白血病較急性非淋巴細(xì)胞白血病敗血癥發(fā)生率高，其中急性淋巴細(xì)胞白血病發(fā)生率為10.63%，急性非淋巴細(xì)胞白血病敗血癥發(fā)生率為6.51%，二者差異經(jīng)統(tǒng)計(jì)P=0.047，有統(tǒng)計(jì)學(xué)意義；中性粒細(xì)胞絕對(duì)值、血漿白蛋白水平越低，敗血癥的發(fā)生率越高；免疫抑制劑、糖皮質(zhì)激素治療及深靜脈置管應(yīng)用為影響敗血癥發(fā)生率的重要因素。2.感染部位：急性白血病并發(fā)敗血癥患者原發(fā)感染部位以呼吸道感染最為常見（占54.4%），其次是腸道（占13.2%）及肛周感染（占10.4%）。3.感染細(xì)菌及藥敏：革蘭氏陰性菌感染率最高，共47例次，占總病原菌的69.1%，以大腸埃希氏菌為主，共26例次，占總病原菌的38.2%；革蘭氏陽性菌中金黃色葡萄球菌及人葡萄球菌人亞種感染率最高，均為5例次，均占總病原菌7.4%；革蘭氏陰性菌對(duì)亞胺培南敏感率最高（為97.8%）；革蘭氏陽性菌對(duì)萬古霉素敏感率最高（為100%）。4.45株革蘭氏陰性菌中ESBLs陽性菌株為30株，陽性率為66.7%，其中17株為應(yīng)用三代頭孢后感染，13株未應(yīng)用三代頭孢感染。 結(jié)論：本研究急性白血病并發(fā)68例次敗血癥患者分析及統(tǒng)計(jì)結(jié)果得出如下結(jié)論： 1.急淋敗血癥的發(fā)生率較急非淋患者高；與糖皮質(zhì)激素及免疫抑制劑使用、粒細(xì)胞缺乏、深靜脈置管及低血漿白蛋白有關(guān)，與年齡無關(guān)。2.發(fā)生敗血癥患者原發(fā)感染灶最常見呼吸道感染，其次是腸道及肛周感染。3.敗血癥以革蘭氏陰性細(xì)菌感染為主，最常見大腸埃希氏菌；合理應(yīng)用抗生素是改善急性白血病并發(fā)敗血癥患者預(yù)后的重要因素；盡量避免經(jīng)驗(yàn)性應(yīng)用三代頭孢，，降低產(chǎn)超廣譜β酰胺酶耐藥菌感染率。
[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.
【學(xué)位授予單位】：遵義醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R733.71;R515.3

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