造血干细胞移植后早期感染的预防及护理

目的探讨造血干细胞移植后早期感染的预防及护理对策。方法对2009年1月-2009年12月在我科接受外周血造血干细胞移植治疗的113例患者临床资料和对早期感染的预防及护理措施进行回顾性分析。结果 113例患者移植后早期感染发生率为92.1%（104/113）,严重感染发生率10.6%（12/113）,死亡5例（4.4%）;首次感染发生的时间为移植后1-10 d,中位时间为第5 d,高峰时间为移植后2-7 d,此时中性粒细胞绝对计数多〈0.5×10^9/L,感染持续时间为2-12 d,感染部位常见的有口咽部、肠道、肛周、会阴等,死亡原因为颅内出血、急性心功能不全和肝静脉阻塞病。结论造血干细胞移植后粒细胞缺乏期是早期感染的高发期,口咽部、消化道、肛周、会阴部等的清洁、抗菌是积极预防和治疗感染的关键,实施有效、可行的预防及护理措施的同时,加强患者的预防和治疗依从性也非常重要。

Prevention and nursing of early infection after hematopoietic stem cell transplantation

Objective To investigate the prevention and nursing countermeasure of early infection after hematopoietic stem cell transplantation（HSCT）.Methods The clinical data of 113 patients were treated with HSCT.The prevention and nursing countermeasure of early infection were retrospectively analyzed.Results The incidence of early infectious complications was 92.1%（104/113） after HSCT.The seriously infectious complications was 10.6%（12/113）.5 patients died（4.4%）.The first occurrence of the early infectious complications was at a median of the 5th day（1-10）,the peak time of incidence was the 2nd day to the 7th day that the count of patient＇s absolute neutrophil mostly more than 0.5×10^9/L.The infection lasted for 2-12 days,oral cavity,pharynx,perianal,perineum and so on were the common positions,the cause to death were intracranial hemorrhage,acute cardiac insufficiency and hepatic veno-occlusive disease.Conclusions After HSCT,the period of granulocyte lacking is the peak time in early infectious complications.The key to positive prevention and treatment of infection is the cleaning of oral cavity,pharynx,perianal,perineum and so on.