Risk factors and preventive nursing measures of acute leukaemia complicated with respiratory tract infection in children
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摘要:
目的 对儿童急性白血病(AL)合并呼吸道感染的危险因素进行分析，通过结果提出预防护理措施，为临床治疗提供参考。 方法 回顾性分析2018年2月—2021年2月温州医科大学附属第二医院收治的140例儿童AL患者，分为呼吸道感染组(72例)和非呼吸道感染组(68例)。收集患者的相关临床资料，分析影响儿童AL合并呼吸道感染的危险因素，并提出预防性护理措施。 结果 重度贫血、白细胞计数＞10×109/L或＜2×109/L、血小板＜20×109/L、低蛋白血症、住院时间延长、化疗方案、预防性应用抗生素是儿童白血病合并呼吸道感染的影响因素(均P＜0.05)；多因素logistic回归分析显示重度贫血(OR=2.440, 95% CI：1.073~5.546)、血小板＜20×109/L(OR=1.972, 95% CI：1.061~3.663)、低蛋白血症(OR=2.959, 95% CI：1.115~7.853)、IA化疗方案(OR=3.799, 95% CI：1.207~11.957)是影响儿童AL合并呼吸道感染的独立危险因素。 结论 儿童AL合并呼吸道感染的危险因素包括重度贫血、血小板＜20×109/L、低蛋白血症、IA化疗方案，临床需针对上述危险因素采取预防性护理措施。 Abstract:Objective To analyse the risk factors of acute leukaemia (AL) complicated with respiratory tract infection in children and to propose preventive nursing measures based on the results, thereby providing reference for clinical treatment. Methods A retrospective analysis was performed on 140 paediatric AL patients admitted to the Second Affiliated Hospital of Wenzhou Medical University from February 2018 to February 2021, who were divided into the respiratory tract infection group (72 cases) and non-respiratory tract infection group (68 cases). Relevant clinical data of the patients were collected to analyse the risk factors affecting children with AL complicated with respiratory tract infection, and the preventive nursing measures were proposed. Results Severe anaemia, white blood cell count >10×109/L or < 2×109/L, platelet < 20×109/L, hypoproteinaemia, prolonged hospital stay, chemotherapy regimen and prophylactic use of antibiotics were the influencing factors of paediatric leukaemia complicated with respiratory tract infection (all P < 0.05). Multivariate logistic regression analysis showed that severe anaemia (OR=2.440, 95% CI: 1.073-5.546), platelet < 20×109/L (OR=1.972, 95% CI: 1.061-3.663), hypoproteinaemia (OR=2.959, 95% CI: 1.115-7.853) and IA chemotherapy regimen (OR=3.799, 95% CI: 1.207-11.957) were independent risk factors for AL complicated with respiratory tract infection in children. Conclusion The risk factors of children with AL complicated with respiratory tract infection include severe anaemia, platelet < 20×109/L, hypoproteinaemia and IA chemotherapy regimen, and preventive nursing measures should be taken in accordance with the above-mentioned risk factors in clinic. -
Key words:
- Acute leukaemia /
- Respiratory tract infection /
- Risk factors
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表 1 影响儿童AL合并呼吸道感染的单因素分析
Table 1. Univariate analysis of factors affecting respiratory infections in children with AL
组别 例数 性别[例(%)] 年龄(x±s，岁) 血红蛋白[例(%)] 白细胞计数[例(%)] 男 女 ＜60 g/L ≥60 g/L (2~10)×109/L ＞10×109/L或＜2×109/L 呼吸道感染组 72 41(56.94) 31(43.06) 8.45±1.58 49(68.06) 23(31.94) 15(20.83) 57(79.17) 非呼吸道感染组 68 40(58.82) 28(41.18) 8.21±1.73 29(42.65) 39(57.35) 29(42.65) 39(57.35) 统计量 0.051a 0.858b 9.150a 7.722a P值 0.822 0.392 0.002 0.005 组别 例数 血小板计数[例(%)] 低蛋白血症[例(%)] 化疗方案[例(%)] 住院时间(x±s，d) ＜30×109/L ≥30×109/L 有 无 IA化疗 DA化疗 呼吸道感染组 72 59(81.94) 13(18.06) 52(72.22) 20(27.78) 39(54.17) 33(45.83) 32.26±3.84 非呼吸道感染组 68 35(51.47) 33(48.53) 27(39.71) 41(60.29) 19(27.94) 49(72.06) 28.53±3.95 统计量 14.721a 15.039a 9.912a 4.146b P值 ＜0.001 ＜0.001 0.002 ＜0.001 组别 例数 预防性抗生素[例(%)] 淋巴细胞计数[例(%)] 骨髓增生程度[例(%)] 是否PICC[例(%)] 是 否 ＞0.5×109/L ≤0.5×109/L 活跃 一般或降低 是 否 呼吸道感染组 72 29(40.28) 43(59.72) 28(38.89) 44(61.11) 51(70.83) 21(29.17) 49(68.06) 23(31.94) 非呼吸道感染组 68 40(58.82) 28(41.18) 31(45.58) 37(54.42) 45(66.18) 23(33.82) 42(61.76) 26(38.24) 统计量 4.812a 0.644a 0.352a 0.608a P值 0.028 0.422 0.553 0.435 注：IA为去甲氧柔红霉素联合阿糖胞苷；DA为柔红霉素联合阿糖胞苷；PICC为经外周静脉行中心静脉置管。a为χ2值，b为t值。 
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表 2 变量赋值方法
Table 2. Variable assignment methods
变量 赋值方法 血红蛋白(g/L) ＜60=1，≥60=2 白细胞计数(×109/L) 2~10=1，＞10或＜2=2 血小板计数(×109/L) ＜30=1，≥30=2 低蛋白血症 无=1，有=2 住院时间(d) 以实际值赋值 化疗方案 IA化疗=1，DA化疗=2 预防性使用抗生素 无=1，有=2 是否合并呼吸道感染 否=1，是=2
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表 3 儿童AL合并呼吸道感染的多因素logistic回归分析
Table 3. Multivariate logistic regression analysis of children with AL complicated with respiratory infections
项目 B SE Wald χ2 P值 OR值 95% CI 重度贫血 0.892 0.419 9.982 0.002 2.440 1.073~5.546 白细胞＞2及＜10(×109/L) 0.436 0.286 3.192 0.074 1.546 0.883~2.709 血小板＜20×109/L 0.679 0.316 7.998 0.005 1.972 1.061~3.663 低蛋白血症 1.085 0.498 13.686 < 0.001 2.959 1.115~7.853 IA化疗方案 1.335 0.585 14.979 < 0.001 3.799 1.207~11.957 住院时间 0.415 0.276 2.889 0.089 1.514 0.882~2.601 预防性使用抗生素 0.453 0.293 1.896 0.169 1.573 0.886~2.793
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