肺癌患者伴肺部感染的临床分析

Clinical study of 68 cases of lung cancer patients with pneumonia

目的探讨肺癌患者伴肺部感染的临床研究。方法对2004-2007年68例肺癌伴肺部感染患者病原学和临床特征进行回顾性研究。结果年龄≥60岁和接受放化疗的患者肺炎发生率较高,鳞癌(47.1%)感染构成比高于腺癌(26.5%)和小细胞癌(14.7%);分离病原菌76株,革兰阴性菌占59.2%,肺炎克雷伯氏菌、不动杆菌属、铜绿假单胞菌、金黄色葡萄球菌、阴沟肠杆菌居前5位;真菌占10.5%;肺炎克雷伯氏菌、不动杆菌属、铜绿假单胞菌、金黄色葡萄球菌出现高比例、多药耐药。结论肺癌伴肺部感染与患者年龄、性别、放化疗以及基础疾病、临床分期密切相关,病原菌以革兰阴性杆菌为主,且存在多药耐药;应根据药敏结果选择抗菌药物,同时加强支持和综合治疗,有益于病人康复。

Objective To study clinical therapy of lung cancer patients with pneumonia. Methods The bacteriology and clinical features of lung cancer patients accompanied with lung infections between 2004 and 2007 were analyzed. Results Pneumonia was diagnosed in 68 patients with lung cancer, and the most of them （ more than 60 years elderly） were received radiation and chemotherapy. The accidence rate of pneumonia associated with squamous cell carcinoma （47.1% ） was higher than those with adenocarcinoma （44. 0% ） and small cell lung carcinoma （14.7%）. Totally 76 strains were isolated from sputum, the most （59.2%） of them which were gram - negative bacilli. The most commonly isolated bacteria were Klebsiella pneumoniae, Pseudomonas aeruginosa, Staphylococcus aureus, Enterobacterspp and Enterobactor cloacae. The rates of pneumonia associated with Epiphyte are （10.5%）. Klebsiella pneumoniae, Pseudomonas aeruginosa, Staphylococcus aureus and Enterobacterspp showed resistance to all the agents tested in different levels, multidrug resistance occurred. Conclusion Pneumonia in patients with lung cancer is associated with age, sex, radiation, chemotherapy, basic disease and clinical stage of the tumor. The most pathogen isolated from sputum specimens were gram - negative bacilli. In therapy, sensitive antibiotics should be selected based on the drug sensitivity tests combined with sustained and synthetical treatment.