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目的探讨儿童恶性血液病化疗期间并发感染性休克的临床特征及预后。方法研究对象为2007-01-01—2010-07-01中山大学孙逸仙纪念医院儿科血液肿瘤区化疗期间发生感染性休克患儿9例。分析患儿发生感染性休克临床特点、实验室检查资料、治疗及死亡高危因素。结果 9例患儿1例放弃治疗,5例死亡,3例治愈,病死率62.5%(5/8)。全部患儿白细胞(WBC)计数<1×109/L,革兰阴性杆菌感染5例,阳性率55.6%(5/9)。粪培养示,革兰阴性乙型副伤寒沙门菌感染1例。双肺感染5例(55.6%),胃肠道感染2例,外周静脉置入中心静脉导管处皮肤感染1例,部位不明感染1例。死亡5例中3例肺部感染,3例多器官功能衰竭。结论血液病患儿感染性休克病原菌以革兰阴性杆菌多见,尤以铜绿假单胞菌居多。化疗期间中性粒细胞低下、严重肺部感染、多器官功能衰竭可能是导致休克及死亡的高危因素,早期、足量、高效广谱抗生素,加强支持疗法对减少病死率具有重要意义。
Objective To investigate the clinical characteristics and prognosis of septic shock in children with hematologic malignancy during chemotherapy. Methods The study was performed on 9 children with septic shock during chemotherapy in the hematologic tumor area of Sun Yat-sen Memorial Hospital of Sun Yat-sen University from January 2007 to October 2010. Analysis of children with septic shock clinical features, laboratory tests, treatment and risk factors for death. Results One patient in 9 cases gave up treatment, 5 patients died and 3 patients were cured. The case fatality rate was 62.5% (5/8). All children with white blood cell (WBC) count <1 × 109 / L, Gram-negative bacilli in 5 cases, the positive rate was 55.6% (5/9). Gram-negative cultures showed a Gram-negative Salmonella paratyphi A infection. Five patients (55.6%) had bilateral lung infection, two had gastrointestinal infection, one had peripheral skin vein infection at the central venous catheter, and one had unidentified infection. Three patients died of pulmonary infection in 5 cases and 3 cases had multiple organ failure. Conclusion Hemorrhagic children with septic shock pathogens more common with gram-negative bacilli, especially Pseudomonas aeruginosa. Chemotherapy during neutropenia, severe pulmonary infection, multiple organ failure may be the risk factors leading to shock and death, early, adequate and efficient broad-spectrum antibiotics, and strengthen supportive therapy to reduce mortality is of great significance.