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目的研究低嗜中性球发热癌症患者的抗生素给药时间与住院天数、死亡率、转入重症监护室之间的关系。方法选取2010年1月~2013年12月来新疆医科大学第一附属医院重症医学科就诊的105例患有低嗜中性球发热的癌症患者,用多国癌症支持治疗联合协会评分对患者进行评估,并分为高风险组和低风险组。运用多变量回归分析统计抗生素给药时间与多种质量相关变量之间的关系。结果 105例患者中,37例(35%)进入高风险组,68例(65%)进入低风险组;52例(49%)有并发疾病,46例(44%)患有恶性血肿瘤,63例(60%)患有危重疾病。高风险组患者以男性为主,且患者患严重内科疾病的比率要显著高于低风险组(P<0.001)。相对实体瘤患者,恶性血肿瘤患者在研究最后3个月发生危重疾病及应用预防性白细胞生长因子和抗生素的比例较大。105例患者的抗生素用药中位时间是2.5 h。9%的患者在入院后1 h接受了抗生素治疗,95%的患者入院后9.3 h内接受了抗生素治疗。入院前3个月内,88例(84%)患者接受的治疗药物为广谱青霉素,50例(47.6%)患者接受了预防性白细胞生长因子或预防性抗生素治疗。患者住院天数为(29±8)天。结论目前的临床诊疗中,仅有10%的患者能够在入院1h内接受抗生素治疗;高风险患者及有已知感染源的患者住院天数较长。
Objective To study the relationship between antibiotic administration time and hospitalization days, mortality and transfer to intensive care unit in patients with low-neutrophil fever. Methods From January 2010 to December 2013, 105 patients with low-neutrophil fever who were admitted to the Department of Critical Care Medicine of the First Affiliated Hospital of Xinjiang Medical University were enrolled in this study. The patients were evaluated by the multinational association of cancer support and treatment , And divided into high-risk group and low-risk group. Multivariate regression analysis was used to analyze the relationship between antibiotic dosing time and various quality-related variables. Results Of the 105 patients, 37 (35%) entered the high-risk group and 68 (65%) entered the low-risk group. Fifty-two (49%) had concurrent disease and 46 (44% 63 cases (60%) had critical illness. The predominantly male patients in the high-risk group had significantly higher rates of severe medical illness than those in the low-risk group (P <0.001). Relative to solid tumor patients, patients with malignant hematologic malignancies have a high incidence of critically ill diseases and the use of prophylactic leukocyte growth factor and antibiotics during the last 3 months of the study. The median time to antibiotic medication in 105 patients was 2.5 h. Nine percent of patients received antibiotics 1 h after admission and 95% received antibiotics within 9.3 h after admission. Three months before admission, 88 (84%) patients received broad-spectrum penicillin and 50 (47.6%) received prophylactic leukocyte growth factor or prophylactic antibiotics. Patients hospitalized for days (29 ± 8) days. Conclusions Only 10% of patients in current clinical practice receive antibiotics within 1 h of admission; patients in high-risk and those with known sources have longer hospital stays.