本文選題：血液病　切入點(diǎn)：惡性　出處：《寧夏醫(yī)科大學(xué)》2012年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：目的探討惡性血液病并發(fā)醫(yī)院獲得性肺炎患者的臨床表現(xiàn)，病原學(xué)特點(diǎn)，影響因素，治療及預(yù)后，為臨床防治提供依據(jù)。 方法對(duì)寧夏醫(yī)科大學(xué)總醫(yī)院血液科2003年7月~2011年7月惡性血液病并發(fā)醫(yī)院獲得性肺炎住院患者資料進(jìn)行回顧性分析。 結(jié)果1.惡性血液病患者醫(yī)院獲得性肺炎的例次發(fā)生率為11.30%，以多發(fā)性骨髓瘤并發(fā)醫(yī)院獲得性肺炎最常見(jiàn)；老年人是感染的高發(fā)人群。2.多數(shù)患者有發(fā)熱、咳嗽，半數(shù)表現(xiàn)為干咳；部分患者伴有畏寒、胸悶、氣短及胸痛；病變大多為雙側(cè)，體征和影像學(xué)以滲出改變?yōu)橹鳎瑢?shí)變征象相對(duì)少見(jiàn)；部分患者合并膿毒癥，少數(shù)患者并發(fā)敗血癥、感染性休克及其它部位感染，病情兇險(xiǎn)。3.痰培養(yǎng)結(jié)果中革蘭氏陰性菌（G~-）占45.16%、革蘭氏陽(yáng)性菌（G~+）占29.03%、真菌占25.80%。4.易感因素與原發(fā)疾病類(lèi)型，年齡，粒細(xì)胞水平，應(yīng)用化療、免疫抑制劑治療及住院時(shí)間長(zhǎng)短等有關(guān)。5.120例次惡性血液病并發(fā)醫(yī)院獲得性肺炎住院患者中，119例次經(jīng)抗感染治療，其中治愈66例次（55.46%），顯效23例次（19.33%），進(jìn)步16例次（13.45%），無(wú)效14例次（11.76%），治療有效率為74.79%（89/119），似低于普通院內(nèi)肺部感染治療有效率。 結(jié)論1.惡性血液病合并醫(yī)院獲得性肺炎發(fā)生率較高，嚴(yán)重威脅患者治療及生存；2.患者大多由典型臨床表現(xiàn)及影像學(xué)而診斷；部分患者缺乏典型臨床表現(xiàn)，需依賴(lài)影像學(xué)早期診斷；少數(shù)患者易進(jìn)展為膿毒癥、敗血癥及感染性休克；3.革蘭氏陰性菌(G-)感染居首位；4.其原發(fā)疾病類(lèi)型，高齡，粒細(xì)胞減少，應(yīng)用化療、免疫抑制劑治療，住院時(shí)間長(zhǎng)是導(dǎo)致醫(yī)院獲得性肺炎的重要因素；5.惡性血液病并發(fā)醫(yī)院獲得性肺炎抗感染治療難度大，需更注重抗菌藥的合理使用。
[Abstract]:Objective to investigate the clinical manifestations, etiological characteristics, influencing factors, treatment and prognosis of patients with hematologic malignancy complicated with hospital acquired pneumonia, and to provide evidence for clinical prevention and treatment. Methods the data of hospitalized patients with nosocomial pneumonia from July 2003 to July 2011 in Hematology Department of Ningxia Medical University General Hospital were retrospectively analyzed. Results 1.The incidence of nosocomial pneumonia in patients with malignant hematologic diseases was 11.30, with multiple myeloma complicated with nosocomial pneumonia being the most common, the elderly being infected with high incidence of nosocomial pneumonia .2. most of the patients had fever, cough, and half of them had dry cough. Some of the patients were accompanied by chills, chest tightness, shortness of breath and chest pain; the lesions were mostly bilateral, the signs and imaging were mainly exudation, and the signs of solid changes were relatively rare; some patients were complicated with sepsis, and a few patients were complicated with sepsis. Infection of septic shock and other sites. 3. In the sputum culture results, Gram-negative bacteria (GC-) accounted for 45.16%, Gram-positive bacteria (G~) for 29.03um, fungi for 25.80.4.The susceptible factors and the types of primary diseases, age, granulocyte level, chemotherapy were used. The treatment of immunosuppressant and length of hospital stay were related to 5.120 cases of malignant hematologic diseases complicated with nosocomial pneumonia. 119 cases were treated with anti-infective therapy. Among them, 66 cases were cured with 55.46 times, 23 cases with remarkable effect and 19.33% with remarkable effect, 16 cases with progress of 13.45 times, 14 cases with no effect and 11.7660%. The effective rate of treatment was 74.79% 89 / 119, which seemed to be lower than the effective rate of treatment of pulmonary infection in general hospital. Conclusion 1. The incidence of nosocomial pneumonia in patients with hematologic malignancies is high, which is a serious threat to the treatment and survival of the patients. 2. Most of the patients are diagnosed by typical clinical manifestations and imaging, and some of the patients lack typical clinical manifestations. 2. A few patients are prone to develop sepsis, septicemia and septic shock. Gram-negative bacteria (G-G) infection is the first infection. 4. Its primary disease type, advanced age, granulocytopenia, chemotherapy, immunosuppressant therapy, Long hospital stay is an important factor leading to nosocomial pneumonia. It is difficult to treat nosocomial pneumonia with malignant hematologic diseases, so it is necessary to pay more attention to the rational use of antimicrobial agents.
【學(xué)位授予單位】：寧夏醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類(lèi)號(hào)】：R563.1

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