摘要
目的:探讨恶性血液病患者医院感染的临床特点,分析引起医院感染的原因和危险因素,为临床防治提供科学依据。方法:对我院血液科342例恶性血液病患者进行回顾性调查分析,其中共发生138例医院感染,对影响医院感染相关因素进行计分析,筛选出医院感染的危险因素;对医院感染的发生率、病原菌分布以及感染部位进行回顾性总结分析;采取病例对照方法对急性非淋巴细胞白血病患者在不同病房化疗进行感染率的比较,以进一步了解恶性血液病患者医院感染特点及高危因素,为临床治疗及预防提供依据。结果:恶性血液病患者医院感染发生率为40.4%,在层流病房医院感染发生率(16.7%)明显低于在血液科普通病房医院感染的发生率(41.3%);感染部位以呼吸道为主,其次为皮肤、血液、肛周等部位;引起院内感染的致病菌仍以革兰阴性杆菌为主,其次是革兰阳性杆菌,再次是真菌感染,但是在不同标本中革兰阴性杆菌、革兰阳性杆菌、真菌的检出率不同。影响医院感染的危险因素单因素分析显示:年龄≥60岁、血红蛋白,血浆白蛋白水平、住院时间、白细胞计数、化疗后ANC降低水平以及粒缺时间、糖皮质激素的应用和侵袭性操作、合并糖尿病是恶性血液病患者医院感染的危险因素;患者性别、民族与医院感染无相关性。结论:恶性血液病患者易发生医院感染,发生率高,高达40.4%,与多种危险因素有关,针对危险因素采取综合性的治疗、护理措施,对医院感染的发生及预后至关重要,给予全环境保护及支持治疗,可有效降低医院感染的发生率。
0bjective: To analyze the risk factors and clinical characteristics of nosocomial infection in patients with Malignant Hematopathy and provide for effective preventive measures. Method: To review and analyze the clinical data and risk factors of nosocomial infection with adopting from 342 patients. The risk factors include ages,sex,ethnic, hospitalized days, the correlated diabetes, white blood cell count, ANC count,ANC decreased sustained time after chemotherapy, the blood plasma albumin, hemoglobin and the application of glucocticoid. The data were analyzed with single-factor analysisχ2 test. Results: Among 342 patiens, 138 patients occurred nosocomial infection. The incidence rate of NI was higher with Malignant Hematopathy, which was related positively to the risk factors except for sex and ethnic. The most common infection position of NI was respiratory tract, gram-negative bacteria is still the most pathogen in our hematology department, secondly that is gram-positive bacteria, the last one is fungus. Conclution: The patients with MH are ealiy susceptible to nosocomial infection.To boost body, denfenses and control the risk factors are effective methods to prevent nosocomial infection of Hematological Malignancies, providing total environmental protection can decrease markly incidence of NI.
引文
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