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目的对急性淋巴细胞白血病化疗后出现低钠血症的患儿临床资料进行分析,总结低钠血症的发病率、病因及临床特点,以提高对该病的认识。方法收集该院血液肿瘤科2011年1月—2014年6月ALL化疗后发生低钠血症的患儿资料,进行统计分析。结果急性淋巴细胞白血病患儿规律治疗103例,发生低钠血症50例,发病率48.5%,其中22例(44%)发生2次或多次低钠血症。发生低钠血症事件74次,血钠水平(129.94±4.82)mmol/L,主要原因为SIADH(31.1%)及摄入不足或经胃肠道丢失(39.2%)。有症状低钠血症26次(35.1%),血钠水平(126.68±6.71)mmol/L;无症状低钠血症48次(64.9%),血钠水平(131.75±1.88)mmol/L,二组间比较,t=-4.92,P=0.00,差异有统计学意义。发生低钠血症时静脉液体钠浓度有症状组为(0.33±0.03)%,无症状组为(0.35±0.03)%,t=-1.76,P=0.08,差异无统计学意义。低钠血症可发生于化疗各阶段,但严重程度及持续时间无明显统计学意义(F=2.51,P=0.06;F=1.91,P=0.14)。CAM方案化疗后低钠血症发病时间明显短于VDLD及VALD阶段,F=6.78,P=0.00。结论儿童急性淋巴细胞白血病化疗中应积极监测电解质水平,如出现恶心、呕吐、意识改变及抽搐等症状时应及时完善相关检查,明确有无低钠血症及其病因,采取合适的治疗。
Objective To analyze the clinical data of children with hyponatremia after chemotherapy for acute lymphoblastic leukemia and summarize the incidence, etiology and clinical features of hyponatremia to improve the understanding of the disease. Methods The data of children with hyponatremia after ALL chemotherapy from January 2011 to June 2014 were collected and analyzed statistically. Results 103 cases of children with acute lymphoblastic leukemia regular treatment, 50 cases of hyponatremia occurred, the incidence rate of 48.5%, of which 22 cases (44%) occurred 2 or more times of hyponatremia. There were 74 episodes of hyponatremia and 129.94 ± 4.82 mmol / L of serum sodium, mainly due to SIADH (31.1%) and inadequate intake or gastrointestinal loss (39.2%). There were 26 (35.1%) cases of symptomatic hyponatremia, 126.68 ± 6.71 mmol / L of serum sodium, 48 (64.9%) asymptomatic hyponatremia and 131.75 ± 1.88 mmol / L of serum sodium, Between the two groups, t = -4.92, P = 0.00, the difference was statistically significant. The occurrence of hyponatremia venous sodium concentration in the symptomatic group was (0.33 ± 0.03)%, asymptomatic group was (0.35 ± 0.03)%, t = -1.76, P = 0.08, the difference was not statistically significant. Hyponatremia can occur in all stages of chemotherapy, but the severity and duration have no statistical significance (F = 2.51, P = 0.06; F = 1.91, P = 0.14). The incidence of hyponatremia after CAM regimen was significantly shorter than VDLD and VALD stage, F = 6.78, P = 0.00. Conclusions Electrolytes should be actively monitored in children with acute lymphoblastic leukemia chemotherapy. In the event of nausea, vomiting, changes in consciousness and convulsions, the related tests should be promptly completed to determine whether there is hyponatremia and its etiology and appropriate treatment is taken.