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目的探讨儿童急性淋巴细胞白血病(ALL)化疗后并发脓毒症的临床及病原学特点。方法回顾性分析2008年4月至2014年12月诊断为ALL并以CCLG-ALL 2008方案化疗后并发血培养阳性脓毒症患儿的临床及病原学资料。结果 545例诊断ALL并以CCLG-ALL2008方案治疗的患儿中112例(145例次)化疗后并发脓毒症,发生率为20.55%。标危和中危组患儿脓毒症高发于诱导缓解治疗阶段,高危组患儿脓毒症高发于巩固治疗阶段。最常见感染部位是呼吸道。血培养病原菌以革兰阳性菌居多。革兰阳性菌对万古霉素、利奈唑胺、替考拉宁敏感率高,革兰阴性菌对美罗培南、亚胺培南敏感率高。高危型、中心静脉置管、中性粒细胞计数<0.1×109/L及中性粒细胞缺乏持续时间>7 d者脓毒症发生率显著升高(P<0.001)。112例患儿治疗有效率95.17%,脓毒症相关病死率1.28%。结论脓毒症是ALL患儿化疗后的重要并发症及死亡原因之一。
Objective To investigate the clinical and etiological characteristics of sepsis in children with acute lymphoblastic leukemia (ALL) after chemotherapy. Methods The clinical and etiological data of children with positive sepsis who were diagnosed as ALL with CCLG-ALL 2008 regimen during April 2008 to December 2014 were analyzed retrospectively. Results Of the 545 children diagnosed with ALL and treated with the CCLG-ALL2008 regimen, 112 (145) patients with sepsis were complicated by chemotherapy, with a rate of 20.55%. Critically endangered and moderate risk group of sepsis patients with high induction induced remission treatment stage, sepsis in high-risk group of high incidence in the consolidation treatment stage. The most common site of infection is the respiratory tract. Gram-positive bacteria in blood culture pathogens mostly. Gram-positive bacteria vancomycin, linezolid, teicoplanin sensitive, gram-negative bacteria sensitive to meropenem, imipenem high. High-risk type, central venous catheterization, neutrophil count <0.1 × 109 / L and neutropenia duration> 7 days were associated with significantly increased sepsis rates (P <0.001). 112 cases of children with effective rate of 95.17%, sepsis-related mortality rate 1.28%. Conclusion Sepsis is an important complication and cause of death in children with ALL after chemotherapy.