以质量求发展，以服务铸品牌

护理学报 ›› 2020, Vol. 27 ›› Issue (23): 53-57.doi: 10.16460/j.issn1008-9969.2020.23.053

• 调查研究 • 上一篇    下一篇

急性白血病患儿住院期间感染性腹泻影响因素病例对照研究

陈琳, 葛铮铮, 张晓艳   

  1. 上海交通大学医学院附属上海儿童医学中心 血液肿瘤科,上海 200127
  • 收稿日期:2020-07-17 出版日期:2020-12-10 发布日期:2021-01-15
  • 通讯作者: 张晓艳(1982-),女,上海人,本科学历,主管护师。E-mail:zhang.xiaoyan@scmc.com.cn
  • 作者简介:陈琳(1991-),女,上海人,本科学历,护师。
  • 基金资助:
    上海市教委护理高原项目(Hlgy16069qnhb)

Case-control Study on Risk Factors of Infectious Diarrhea in Hospitalized Children with Acute Leukemia

CHEN Lin, GE Zheng-zheng, ZHANG Xiao-yan   

  1. Dept. of Hematology and Oncology,Shanghai Children's Medical Center,School of Medicine,Shanghai Jiaotong University,Shanghai 200127,China
  • Received:2020-07-17 Online:2020-12-10 Published:2021-01-15

PDF (PC)

509

赞

摘要： 目的 探讨急性白血病住院患儿发生感染性腹泻的影响因素。方法 回顾性分析2017年7月—2018年7月上海市某三级甲等儿童专科医院内急性白血病患儿的临床资料,根据是否发生感染性腹泻,分为感染性腹泻组(n=48)和非感染性腹泻组(n=1 293),对影响感染性腹泻的相关因素进行二分类Logistic回归分析。结果 1 341例急性白血病住院患儿中有48例发生感染性腹泻,发生率为3.58%。二分类Logistic回归分析结果显示,使用过阿糖胞苷、使用过蒽环类药物、使用过糖皮质激素、有过输血治疗、住院时处于夏季、非固体饮食是急性白血病患儿发生感染性腹泻的危险因素(P<0.05);身高是急性白血病患儿发生感染性腹泻的保护性因素(P<0.05)。结论 使用过阿糖胞苷、蒽环类药物、糖皮质激素、有过输血治疗、住院时处于夏季、非固体饮食的急性白血病患儿会增加感染性腹泻发生的风险;身高越高的急性白血病患儿发生感染性腹泻的风险低。应加强早期风险评估、健康宣教、及预防干预措施,以降低高危患儿的感染性腹泻发生率。

关键词: 急性白血病, 感染性腹泻, 保护性因素, 危险因素

Abstract: Objective To explore the risk factors for infectious diarrhea in hospitalized children with acute leukemia.Methods We conducted a retrospective analysis of the data of hospitalized pediatric patients with infectious diarrhea in a specialized pediatric hospital in Shanghai from July 2017 to July 2018,and children were divided into infectious diarrhea group (n=48),and control group without infectious diarrhea(n=1,293).Binary logistic regression analysis was carried out to explore the risk factors of infectious diarrhea.Results There were 48 cases of infectious diarrhea in 1,341 patients with acute leukemia,with an incidence rate of 3.58%.Binary logistic regression analysis showed that anthracyclines,cytarabine,glucocorticoids,blood transfusion,admitting in summer and non-solid food were risk factors of infectious diarrhea in hospitalized children with acute leukemia (P<0.05).And the results also showed that the higher height was the protective factor for infectious diarrhea in leukemia patients(P<0.05).Conclusion Hospitalized pediatric patients with anthracyclines,cytarabine or glucocorticoids or blood transfusion,admitting in summer,or having non-solid food would be at higher risk of infectious diarrhea but those with higher height have the lower risk of infectious diarrhea.Early assessment of risk factors,health instructions,and preventions should be emphasized to decrease the incidences of infectious diarrhea.

Key words: acute leukemia, infectious diarrhea, protective factor, risk factor

中图分类号: 

  • R473.72
[1] Davidoff AM.Pediatric Oncology[J].Semin Pediatr Surg,2010,19(3):225-233.DOI:10.1053/j.sempedsurg.2010.03.007.
[2] Rodgers CC,Hooke MC,Taylor OA,et al.Childhood Cancer Symptom Cluster:Leukemia and Health-related Quality of Life[J].Oncol Nurs Forum,2019,46(2):228-237.DOI:10.1188/19.ONF.228-237.
[3] Li R,Ma J,Chan Y,et al.Symptom Clusters and Influencing Factors in Children with Acute Leukemia During Chemotherapy[J].Cancer Nurs,2019(4):1-8.DOI:10.1097/NCC.0000000000000716.
[4] 汤静燕,李志光.儿童肿瘤诊断治疗学[M].北京:人民军医出版社,2011:542-545.
[5] 蔡玮,吴智绚,孙丹,等.急性白血病患儿化疗后中性粒细胞缺乏性肠炎的护理[J].护理学杂志,2015,30(3):31-32.DOI:10.3870/hlxzz.2015.03.031.
[6] Knox HT,Charles RT.Oncologic Emergency Medicine[M].New York:Springer International Publishing,2016:319-325.DOI:10.1007/978-3-319-26387-8_27.
[7] 中华人民共和国卫生部.医院感染诊断标准(试行)[J].中华医学杂志,2001,81(5):314-320.DOI:10.3760/j:issn:0376-2491.2001.05.027.
[8] 魏凤江,胡良平.PASS软件在观察性研究设计样本含量估算中的应用[J].四川精神卫生,2017,30(5):401-404.DOI:10.11886/j.issn.1007-3256.2017.05.002.
[9] Bryant AL,Deal AM,Walton A,et al.Use of ED and Hospital Services for Patients with Acute Leukemia after Induction Therapy:One Year Follow-up[J].Leuk Res,2015,39(4):406-410.DOI:10.1016/j.leukres.2015.01.006.
[10] 白艳玲.急性白血病患者院内感染危险因素及护理对策研究[D].西安:第四军医大学,2012.DOI:10.7666/d.d221014.
[11] 周文锦,俞康,郑翠苹,等.白血病患者血流感染危险因素分析[J].中华医院感染学杂志,2013,23(22):5421-5422,5425.
[12] Pereira CA,Marra AR,Camargo LF,et al.Nosocomial Bloodstream Infections in Brazilian Pediatric Patients:Microbiology,Epidemiology,and Clinical Features[J].PloS One,2013,8(7):e68144.DOI:10.1371/journal.pone.0068144.
[13] Lo N.Antibiotic Prophylaxis in Chemotherapy-induced Neutropenia:Time to Reconsider[J].Hematol Oncol,2006,24(3):120-125.DOI:10.1002/hon.783.
[14] Ganguly E,Sharma PK.Prevalence and Risk Factors of Diarrhea Morbidity Among Under-five Children in India:A Systematic Review and Meta-analysis[J].Indian J Child Health (Bhopal),2015,2(4):152-160.
[15] Kumar SG.Diarrhoeal Diseases in Developing Countries:A Situational Analysis[J].Kathmandu Univ Med J (KUMJ),2012,10(38):83-88.DOI:10.3126/kumj.v10i2.7351.
[16] Shah D,Choudhury P,Gupta P,et al.Promoting Appropriate Management of Diarrhea:A Systematic Review of Literature for Advocacy and Action:UNICEF-PHFI Series On Newborn and Child Health,India[J].Indian Pediatr,2012,49(8):627-649.DOI:10.1007/S13312-012-0134-1.
[17] 冯芳茗,楼建华,徐红,等.癌症患儿症状体验的现况调查[J].中国护理管理,2012,12(1):30-34.DOI:10.3969/j.issn.1672-1756.2012.01.010.
[18] Ye ZJ,Zhang Z,Liang MZ,et al.Symptoms and Management of Children with Incurable Cancer in Mainland China[J].Eur J Oncol Nurs,2019,38:42-49.DOI:10.1016/j.ejon.2018.11.005.
[19] Rohde JM,Dimcheff DE,Blumberg N,et al.Health Care-Associated Infection after Red Blood Cell Transfusion:A Systematic Review and Meta-analysis[J].JAMA,2014,311(13):1317-1326.DOI:10.1001/jama.2014.2726.
[20] Zhang L,Liao Q,Zhang T,et al.Blood Transfusion is an Independent Risk Factor for Postoperative Serious Infectious Complications after Pancreaticoduodenectomy[J].World J Surg,2016,40(10):2507-2512.DOI:10.1007/s00268-016-3553-7.
[21] 朱鑫方,夏荣.输血相关免疫调节机制研究进展[J].中国实验血液学杂志,2010,18(1):268-272.
[22] Lannan KL,Sahler J,Spinelli SL,et al.Transfusion Immunomodulation—the Case for Leukoreduced and (Perhaps)Washed Transfusions[J].Blood Cells Mol Dis,2013,50(1):61-68.DOI:10.1016/j.bcmd.2012.08.009.
[23] 蒋学兵,张立萍,王燕菊,等.临床输血与肿瘤治疗研究进展[J].中国实验血液学杂志,2010,18(4):1092-1095.
[24] 李书坛,唐柳,陈晓敏,等.成人急性髓系白血病患者化疗后发生院内感染影响因素及其防治对策研究[J].中国实验血液学杂志,2018,26(2):412-416.DOI:10.7534/j.issn.1009-2137.2018.02.017.
[25] 刘晓艳,党西强,万伍卿,等.小儿急性白血病医院感染危险因素的非条件Logistic回归分析[J].中国当代儿科杂志,2001,3(3):257-259.DOI:10.3969/j.issn.1008-8830.2001.03.015.
[26] Zembower TR.Epidemiology of Infections in Cancer Patients[J].Cancer Treat Res,2014,161:43-89.DOI:10.1007/978-3-319-04220-6_2.
[27] 申佳,杨瀚.综合防治措施对大剂量阿糖胞苷巩固治疗小儿白血病不良反应的预防作用[J].西安交通大学学报(医学版),2015,36(5):718-720.DOI:10.7652/jdyxb201505029.
[28] 汪玉芳,柯金勇.不同剂量阿糖胞苷在86例急性髓性白血病巩固治疗中的疗效与安全性分析[J].肿瘤学杂志,2018,24(4):403-405.DOI:10.11735/j.issn.1671-170X.2018.04.B024.
[29] 王旖然,郭梅,余长林,等.IAT与MAT化疗方案治疗难治和复发性急性髓系白血病的疗效观察[J].中国实验血液学杂志,2012,20(4):884-888.
[30] Kuiken NS,Rings EH,Tissing WJ.Risk Analysis,Diagnosis and Management of Gastrointestinal Mucositis in Pediatric Cancer Patients[J].Crit Rev Oncol Hematol,2015,94(1):87-97.DOI:10.1016/j.critrevonc.2014.12.009.
[31] 衣晓丽,刘晓明,刘天峰,等.CCLG-ALL2008方案治疗303例儿童ALL诱导期感染并发症分析[J].中国小儿血液与肿瘤杂志,2017,22(6):286-291.DOI:10.3969/j.issn.1673-5323.2017.06.002.
[32] Dare JM,Moppett JP,Shield JP,et al.The Impact of Hyperglycemia on Risk of Infection and Early Death During Induction Therapy for Acute Lymphoblastic Leukemia (ALL)[J].Pediatr Blood Cancer,2013,60(12):E157-9.DOI:10.1002/pbc.24689.
[33] 杨清儒,杨璐舟.糖皮质激素的副作用及并发症对策[J].中国现代医生,2008,46(3):31-32.DOI:10.3969/j.issn.1673-9701.2008.03.014.
[34] 刘冬冬,梁颖,李楠,等.天津市6~24个月婴幼儿辅食能量与营养密度调查[J].临床儿科杂志,2005,23(8):571-573.DOI:10.3969/j.issn.1000-3606.2005.08.028.
[35] 谢和宾,曾鸿,尹柯,等.急性白血病患者医院感染危险因素的Meta分析[J].中华医院感染学杂志,2017,27(18):4136-4138.DOI:10.11816/cn.ni.2017-172523.
[36] 阮洋,莫丽亚,邹爱军.2016-2018年湖南地区儿童感染性腹泻病原学监测结果分析[J].实用预防医学,2019,26(11):1372-1374.DOI:10.3969/j.issn.1006-3110.2019.11.025.
[37] 苗永红.儿童感染性腹泻流行病学调查及相关危险因素分析[J].中国妇幼保健,2015,30(27):4685-4688.DOI:10.7620/zgfybj.j.issn.1001-4411.2015.27.42.
[38] 富振英,何武,陈春明.中国6岁以下儿童呼吸系统疾病与腹泻患病情况及经济损失[J].卫生研究,2000,29(5):283-287.DOI:10.3969/j.issn.1000-8020.2000.05.008.
[39] 格鹏飞,王玉.甘肃省5岁以下儿童生长发育与呼吸系统疾病及腹泻患病率关系的分析[J].卫生职业教育,2004,22(16):86-87.DOI:10.3969/j.issn.1671-1246.2004.16.070.
[40] Shane AL,Mody RK,Crump JA,et al.2017 Infectious Diseases Society of America Clinical Practice Guidelines for the Diagnosis and Management of Infectious Diarrhea[J].Clin Infect Dis,2017,65(12):1963-1973.DOI:10.1093/cid/cix959.
[41] 陈晓燕,蒋秀美.粒细胞缺乏症48例保护性隔离的护理体会[J].齐鲁护理杂志,2009,15(11):48-49.DOI:10.3969/j.issn.1006-7256.2009.11.025.
[42] 金卫群.血液病房医院感染管理及控制[J].中华医院感染学杂志,2009,19(12):1538-1540.DOI:10.3321/j.issn:1005-4529.2009.12.025.
[43] Florez ID,Niño-Serna LF,Beltrán-Arroyave CP.Acute Infectious Diarrhea and Gastroenteritis in Children[J].Curr Infect Dis Rep,2020,22(2):4.DOI:10.1007/s11908-020-0713-6.
[1] 邢春凤, 李国新, 张广清, 刘雅鑫, 孙晓伟. 产妇产褥期乳房胀痛危险因素分析及风险预测模型构建[J]. 护理学报, 2024, 31(3): 6-11.
[2] 赵国瑞, 刘高明, 张凤, 周颖. 宫颈癌患者术后下肢淋巴水肿风险预测模型的构建及验证[J]. 护理学报, 2024, 31(24): 7-12.
[3] 胡宁宁, 李玉凤, 王仁媛, 李婉君, 林素兰. 学龄前儿童超重肥胖现状及影响因素分析[J]. 护理学报, 2024, 31(2): 16-21.
[4] 邬馨益, 徐林燕, 陈卓琦, 朱徐乐, 赵磊. 老年人运动认知功能减退综合征风险预测模型的构建与验证[J]. 护理学报, 2024, 31(10): 73-78.
[5] 孙菲, 刘敏, 胡珊珊, 吴蕾, 刘君, 李萍. 基于Meta分析构建早产儿母亲泌乳建立风险预测评分模型[J]. 护理学报, 2023, 30(23): 1-5.
[6] 张海燕, 于卫华, 张利, 任影, 郑俊俊. 2型糖尿病老年患者生活空间移动性受限风险预测模型研究[J]. 护理学报, 2023, 30(22): 13-19.
[7] 方加, 许丽玲, 刘春琴, 刘霞, 王妹香, 刘琼, 黄海英, 肖新华, 林艳. 白血病儿童化疗多维症状体验的同期症状网络分析[J]. 护理学报, 2023, 30(16): 1-6.
[8] 姚晶晶, 刘颖, 许汇娟, 孙思敏, 陈敏, 江雪杰. 急性白血病患者化疗相关便秘预防和管理的循证护理实践[J]. 护理学报, 2022, 29(8): 40-45.
[9] 罗玉勤, 李孟璇, 程秋, 王婷, 郑晶予, 方进博, 龚玉萍. 血液肿瘤患者化疗后肛周感染危险因素病例对照研究[J]. 护理学报, 2022, 29(7): 7-11.
[10] 杨洁, 谢小华, 连万成, 杨梅, 邓丽萍, 潘璐. 急性缺血性脑卒中静脉溶栓后出血预测模型的构建与验证[J]. 护理学报, 2022, 29(5): 10-14.
[11] 向御婷, 褚婕, 严敏, 乐曲, 余嘉欣. 孕产妇孕产期静脉血栓栓塞风险评估的最佳证据总结[J]. 护理学报, 2022, 29(3): 46-51.
[12] 赵晓蕊, 龙云, 陈思齐, 白洁, 肖霄, 朱社宁. 妇科恶性肿瘤患者术后胃肠功能紊乱风险预测模型的构建及验证[J]. 护理学报, 2022, 29(3): 72-78.
[13] 邓颖, 黄山, 胡慧秀, 孙超. 衰弱对老年短暂性脑缺血发作患者预后的影响[J]. 护理学报, 2022, 29(20): 1-5.
[14] 马帅, 温慧, 李玉培, 李灵, 郭迎坤, 乔建红. 产科肛门括约肌损伤危险因素及预防措施研究进展[J]. 护理学报, 2022, 29(20): 26-31.
[15] 陈昕灏, 卢根娣. 缺血性脑卒中后认知障碍危险因素前瞻性队列研究[J]. 护理学报, 2022, 29(18): 6-11.
Viewed
Full text


Abstract

Cited
  Shared   
No Suggested Reading articles found!