肿瘤化疗后白细胞降低患者发热和感染分析.docVIP

肿瘤化疗后白细胞降低患者发热和感染分析 　　【摘要】目的:了解化疗后白细胞降低患者发热及感染发生规律，探讨相关性。方法:观察肿瘤患者化疗后血白细胞数变化、发热及医院感染情况。结果:观察431例肿瘤化疗患者，血白细胞降低发生率48.96%，发热发生率19.26%；医院感染率11.83%。发热、医院感染发生率与白细胞降低程度相关。医院感染发生部位以呼吸道为主(52.94 %) 。感染患者病原菌检出最多的是大肠埃希菌、肺炎克雷伯菌、葡萄球菌和铜绿假单胞菌。结论:对化疗后白细胞降低的患者，应密切观察体温变化，采取医院感染预防措施。对感染者应积极确定病原微生物，合理使用抗菌药物。 　　 【关键词】肿瘤化疗；血白细胞降低；发热；医院感染 　　Analysis on fever and infection suffered by patients with decreased white blood cells after chemotherapy 　　CHEN Xu-fangWangYi 　　【Abstract】 Objective .To find out how fever and infection occur in patients with decreased white blood cells after chemotherapy,and to explore its relevance. Method Observe m alignant tumor patients after chemotherapy about the changes in the number of white blood cell,fever,and hospital infection. Result Of 431 chemotherapy patients,48.96% were found to have decreased white blood cells,19.26% were found to have caught a fever,11.83% were found to have nosocomial infection.Fever,nosocomial infection rates are closely related with the degree of decrease in white blood cells. Most infection occurred in the respiratory tract (52.94%).Pathogens were detected in mostly as E.coli,Klebsiella,Staphylococcus and Pseudompnas.Conclusion Patients with decreased white blood cells after chemotherapy should be closely observed about their body temperature changes,and comprehensive measures should be adopted to prevent nosocomial infections.Pathogenic microorganisms should be actively identified,antimicrobial drugs should be used accordingly. 　　【Keywords】Chemotherapy for m alignant tumor patients；the white blood cells ；nosocomial infection 　　【中图分类号】R256【文献标识码】A【文章编号】1005-0515(2011)04-0197-02 　　发热及感染是恶性肿瘤化疗后白细胞降低患者最常见的并发症。虽然感染能够引起发热，但有些肿瘤本身也可出现发热。临床对发热患者是否感染存在争议，这直接影响到治疗和用药的选择。为了解化疗后白细胞降低患者发热及感染发生情况，并探讨二者之间的关系，我们对肿瘤化疗后白细胞降低的211 例患者中发生的发热及感染病例进行临床分析。现将结果报告如下。 　　1 对象与方法 　　1.1研究对象 2008年1月~2010年6月来医院接受化疗的患者，经病理或细胞学证实为肺癌、乳腺癌、胃癌、大肠癌、卵巢癌，化疗前白细胞数正常（4.0×10?9/L以上），无发热（体温＜37.50C），无严重心、肝、肾等疾病以及其它引起发热的疾病。 　　 1.2 观察指标化疗结束后隔日检查血常规1次，血白细胞数低于4.0×10?