食管癌患者放疗后肺部感染相关因素及抗菌药物应用分析

Analysis of related factors and application of antimicrobial agents of lung infections in patients with esophageal cancer after radiotherapy

目的分析食管癌患者放疗后肺部感染的相关因素及抗菌药物应用,为临床治疗提供参考。方法选择医院2011年3月-2013年3月216例食管癌放疗患者资料,根据是否并发肺部感染将其分为感染组41例和未感染组175例,对两组患者的临床资料进行分析,探讨食管癌患者发生肺部感染的相关因素,并根据治疗结果分析其抗菌药物的应用。结果 216例患者中并发肺部感染41例,感染率为18.98%;病理分期、高龄、长期吸烟、合并糖尿病、长期使用糖皮质激素、合并支气管疾病及肺气肿、通气功能障碍、营养状况差、肿瘤长度长、肿瘤位置是肺部感染的主要影响因素,差异有统计学意义(P<0.05);共分离出病原菌49株,其中革兰阴性菌21株占51.22%,其对临床常用的氨苄西林100.00%耐药;经综合治疗后38例患者感染于2~3周得到控制,3例患者死亡,病死率为7.32%。结论食管癌患者放疗后肺部感染的的因素较多,掌握感染的相关因素,在化疗前进行评估,并采取针对性的措施,如积极治疗基础疾病,加强营养、戒烟等,可降低感染,同时感染发生后,应及时诊断并合理使用抗菌药物。

OBJECTIVE To analyze the related factors and application of antimicrobial agents of lung infection in patients with esophageal Cancer after radiotherapy, and to provide reference for clinical treatment. METHODS The clinical data of a total of 216 cases of patients with esophageal carcinoma after radiotherapy in our hospital from Mar. 2011 to Mar. 2013 were selected, and were divided into infection group and control group according to the existence of pulmonary infections. The clinical data of patients in the two groups were analyzed to explore the related factors of lung infections in patients with esophageal carcinoma, and application of antibacterial drug were analyzed according to the results of treatment. RESULTS Among 216 patients, a total of 41 patients were complicated by pulmonary infections, and the infection rate was 18.98%. Pathologic stage, advanced age, long- term smoking, combined diabetes, long-term use of corticosteroids, bronchial diseases and emphysema, ventilator dysfunction, poor nutritional status, long tumor length, tumor location were the main factors of the lung infections, and the difference between the two groups was significant（P^0. 05）. A total of 49 pathogens were isolated, of which 21 strains were gram-negative bacteria（51. 22%）, which were resistant to the ampicillin （antimicrobial agents commonly used in clinical）. After combined treatment, infections in 38 patients were under control in 2--3 weeks, and three patients died, the mortality rate was 7.32%. CONCLUSION There are many related factors of lung infections in the patients with esophageal cancer after radiotherapy, so controlling the related factors of infections and assessing them before chemotherapy, as well as taking targeted measures, such as the aggressive treatment of the underlying disease, nutrition, smoking cessation, can reduce the infections, while infection occurred, timely diagnosis and rational use of antimicrobial drugs should be performed for the patients.