CAJ | 학술논문

目的：研究恶性肿瘤患者大剂量化疗阶段出现粒细胞缺乏导致感染的发生率及抗生素治疗效果。方法将290例恶性肿瘤患者，依据是否发热将其分为研究组（发热＝161）及对照组（未发热＝129），并根据治疗方案分为A方案（多西他赛＋噻替哌＋卡铂）和B方案（多西他赛＋噻替哌）及是否采用抗生素干预治疗进行分层分析。结果 A方案粒细胞缺乏症发生率为98．9％（176／178），与B方案[94．6％（106／112）]差异不显著（P＞0．05）。 A方案发热发生率为57．3％（102／178），与B方案57．1％[（64／112）]无统计学差异（P＞0．05）。使用抗生素预防患者发热发生率（40．7％）与未采取抗生素预防者的（63．1％）有明显差异（P＜0．05）。研究组粒细胞缺乏症的持续时间达到（4．63±1．74） d，显著长于对照组的（3．17±1．83）d（P＜0．01）。研究组中性粒细胞（0．011±0．009）×109L-1，显著低于对照组中性粒细胞（0．032±0．015）×109 L-1（ P＜0．05）。两组治疗有效率均达到100％，未见死亡患者。结论肿瘤患者大剂量化疗，一旦发生发热，应予促粒细胞生长因子及造血干细胞自身回输，并行抗真菌治疗及广谱抗生素治疗，从而使患者安全度过粒细胞缺乏期，提高肿瘤患者的临床治疗效果。
목적：연구악성종류환자대제양화료계단출현립세포결핍도치감염적발생솔급항생소치료효과。방법장290례악성종류환자，의거시부발열장기분위연구조（발열＝161）급대조조（미발열＝129），병근거치료방안분위A방안（다서타새＋새체고＋잡박）화B방안（다서타새＋새체고）급시부채용항생소간예치료진행분층분석。결과 A방안립세포결핍증발생솔위98．9％（176／178），여B방안[94．6％（106／112）]차이불현저（P＞0．05）。 A방안발열발생솔위57．3％（102／178），여B방안57．1％[（64／112）]무통계학차이（P＞0．05）。사용항생소예방환자발열발생솔（40．7％）여미채취항생소예방자적（63．1％）유명현차이（P＜0．05）。연구조립세포결핍증적지속시간체도（4．63±1．74） d，현저장우대조조적（3．17±1．83）d（P＜0．01）。연구조중성립세포（0．011±0．009）×109L-1，현저저우대조조중성립세포（0．032±0．015）×109 L-1（ P＜0．05）。량조치료유효솔균체도100％，미견사망환자。결론종류환자대제양화료，일단발생발열，응여촉립세포생장인자급조혈간세포자신회수，병행항진균치료급엄보항생소치료，종이사환자안전도과립세포결핍기，제고종류환자적림상치료효과。
Objective To study the incidence of infection caused by agranulocytosis due to high dose chemotherapy in patients with malignant tumor,and efficacy of antibiotics.Methods 290 cases of malignant tumor patients,based on whether had a fever,were divided into the study group(fever=161) and the control group(without fever=129);and according to the treat-ment plan were divided into scheme A( docetaxel+thiotepa+carboplatin) ,scheme B ( docetaxel+thiotepa) and whether to use the antibiotic intervention treatment stratified analysis.Results The incidence of agranulocytosis between scheme A 98.9%(176/178) and scheme B 94.6%(106/112) had no significant difference(P>0.05).The incidence of fever between scheme A 57.3%(102/178) and scheme B 57.1%(64/112) had no significant difference(P>0.05).The incidence of fever between pa-tients treated with antibiotic prophylaxis(40.7%)and those who did not(63.1%) had significant difference(P<0.05).The du-ration of agranulocytosis in the study group was(4.63+1.74) d,which was significantly higher than that of the control group (3.17+1.83) d(P<0.01).Neutrophils in the study group was(0.011+0.009) ×109L-1,which was significantly lower than that of the control group(0.032+0.015) ×109L-1(P<0.05).The effective rate of the two groups were 100%,there had no death.Conclusion High dose chemotherapy treated with tumor patients,in case of fever,should promote myeloid growth factors and hematopoietic stem cell self reinfusion,and apply anti fungal and broad-spectrum antibiotics treatment,to ensure patients safe-ly pass agranulocytosis period,and improve the clinical efficacy of tumor patients.