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以胸腔积液为首发表现的恶性血液肿瘤三例

Clinical Analysis of Neoplastic Hematological Disorder Complicated with Infection in Children

目的：探讨儿童血液肿瘤并发感染的病原菌分布及对抗生素的敏感性，以指导临床治疗。方法:回顾性分析从儿童血液肿瘤患者收集的标本中分离的病原菌及药敏实验资料。结果:共送检321份标本，检出致病菌94株，检出率29.3%，其中革兰氏阴性菌51株(54.3%)、革兰氏阳性菌33株(35.1%)、真菌10株(10.6%)；除铜绿假单胞菌外，革兰氏阴性杆菌对亚胺培南、美洛培南的耐药率较低(lt;15%)，对其他抗生素耐药性较高，三种主要革兰氏阴性菌大肠埃希氏菌、肺炎克雷伯菌、铜绿假单胞菌对氨苄西林几乎耐药(gt;90%)；革兰氏阳性球菌对替考拉宁耐药率较低，对其他抗生素耐药性较高，未检出耐万古霉素菌株。结论:儿童血液肿瘤并发感染的病原菌以革兰氏阴性菌为主。抗生素的大量使用，使革兰氏阴性菌和阳性菌的耐药率都增高，应根据细菌培养及药敏实验指导临床合理使用抗生素。

头孢吡肟联合阿米卡星治疗血液肿瘤粒缺期细菌性肺炎的疗效观察

目的:观察头孢吡肟联合阿米卡星治疗血液肿瘤粒缺期细菌性肺炎的疗效和不良反应。方法:120例入选患者随机分为治疗组和对照组,每组60例,分别接受头孢吡肟联合阿米卡星及头孢他啶联合阿米卡星治疗。其中,头孢吡肟或头孢他啶均为2g加入生理盐水100mL,每日2次,静脉点滴;阿米卡星0.4g,加入生理盐水500mL中,每日1次,静脉点滴,治疗持续一般1～2周。采用卫生部1993年抗菌药物临床研究指导原则进行判断疗效.结果:治疗组与对照组有效率分别为80%、76.7%,细菌清除率分别为91.9%、90.2%。两组比较差异无统计学意义(Pgt;0．05)。两组患者共分离出病原菌123株,药敏试验显示对头孢吡肟的敏感率为90.2%,显著高于头孢他啶69.7%,差异有统计学意义(Plt;0．01)。不良反应主要有恶心及皮疹等,均可耐受。发生率分别为5%和11%,两组比较差异无统计学意义(Pgt;0．05)。结论:头孢吡肟联合阿米卡星治疗血液肿瘤粒缺期细菌性肺炎的疗效略优于头孢他啶组,体外抗菌活性显著优于头孢他啶组。

研究护士对血液肿瘤临床试验药品的管理

从对血液肿瘤临床试验药品的接收、保存、领取、药物配制、给药流程、临床试验用药的盘点、回收等方面，总结药物临床试验中研究护士对血液肿瘤临床试验药品的管理。不难看出，对血液肿瘤临床试验药品规范的管理，是保障血液肿瘤药物临床试验顺利进行的关键。

The Interpretation of the ECL-3 Guideline

Efficacy of palifermin on oral mucositis and aGVHD for hematological malignancy patients undergoing hematopoietic stem cell transplantation: a meta-analysis

ObjectivesTo systematically review the efficacy and safety of palifermin on oral mucositis (OM) and acute graft versus host disease (aGVHD) for hematological malignancy patients undergoing hematopoietic stem cell transplantation (HSCT).MethodsPubMed, The Cochrane Library, Web of Science, EMbase, Clinicaltrials.gov, CNKI and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) of the efficacy of palifermin on OM and aGVHD for hematological malignancy patients undergoing HSCT from inception to September 30th, 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 7 RCTs involving 904 patients were included. The results of meta-analysis showed that: palifermin could reduce the duration of OM grade 2 to 4 (MD=−4.21, 95%CI −7.83 to −0.58, P=0.02), OM grade 3 to 4 (MD=−2.54, 95%CI −4.61 to −0.46, P=0.02) significantly for hematological malignancy patients undergoing HSCT. However, no significant difference was found in the prevalence of aGVHD grade 2 to 4 (RR=1.29, 95%CI 0.95 to 1.75, P=0.11), aGVHD grade 3 to 4 (RR=0.99, 95%CI 0.55 to 1.77, P=0.97), OM grade 2 to 4 (RR=0.86, 95%CI 0.72 to 1.03, P=0.11) and OM grade 3 to 4 (RR=0.82, 95%CI 0.65 to 1.03, P=0.08) between palifermin group and placebo group. The prevalence of paresthesia (RR=4.24, 95%CI 1.24 to 14.56, P=0.02) and erythema (RR=1.49, 95%CI 1.06 to 2.09, P=0.02) were significantly higher in palifermin group.ConclusionsThe durations of OM grade 2 to 4, 3 to 4 are significantly reduce in patients receiving palifermin compared with those receiving a placebo, however, no statistically significant difference are found in the incidence of aGVHD grade 2 to 4, 3 to 4, OM grade 2 to 4, 3 to 4. Parethesia and erythema are more prevalent among patients using palifermin. Therefore, advantages and disadvantages of palifermin should be considered when used in clinical.