肺癌化疗后肺部感染的感染菌谱变化及抗生素疗效观察

Infectious bacterial spectrum changes of lung cancer and its curative effect of antibiotics for pulmonary infection after chemotherapy

目的 比较晚期肺癌（ⅢB期及Ⅳ期）患者化疗前、后肺部感染菌谱分布特点及其对抗生素敏感性的变化,探索化疗患者的最佳抗生素使用方案.方法 采集广西壮族自治区龙潭医院2008年1月～2013年5月住院治疗的362例晚期非小细胞肺癌合并肺部感染患者化疗前、后痰标本进行病原菌培养,并作常用抗生素药敏试验,对结果进行统计学分析.根据药敏结果,将362例肺癌化疗后肺部感染患者随机分为观察组192例和对照组170例,观察组给予头孢哌酮舒巴坦钠对照组给予氨苄西林.结果 阳性菌株（依常见程度）在化疗前和化疗后的符合统计学的数据显示,包括的细菌有白色念珠菌等的菌株,无统计学差异（Z=-0.005,P =0.996）.化疗前、后主要敏感抗生素为头孢哌酮/舒巴坦、头孢他啶等,其敏感性变化无统计学差异.氨苄西林、亚胺培南、左旋氧氟沙星的耐药性显示为升高,头孢唑啉的耐药性显示降低,统计学意义上均有差异.观察组中使用的抗感染药物为头孢哌酮舒巴坦在治疗后的数据中显示治愈率达到92.2％;对照组中抗感染药物为氨苄西林,其治愈率为58.2％.观察组治疗效果显著优于对照组（P＜0.05）.对照组中的X胸片有效率为60.6％,观察组的X胸片有效率为93.3％ （P ＜0.05）.在治疗的过程中二重感染的现象在观察组和对照组的出现的几率无统计学差异.结论 晚期肺癌患者化疗前、后肺部感染病菌谱变化不明显;化疗对各主要敏感抗生素敏感性影响不大;头孢哌酮舒巴坦钠治疗肺癌化疗后肺部感染的疗效满意,不良反应小.

Objective To compare advanced lung cancer（ stage B and stage Ⅳ） before chemotherapy,patients with pulmonary infection after bacteria spectrum distribution characteristics and variation of susceptibility to antibiotics,and explore the best antibiotic chemotherapy in patients with the program. Methods From January 2008 to May 2013,362 cases of hospitalized advanced non small cell lung cancer complicated with pulmonary infection patients before and after chemotherapy collected in our hospital,and their sputum specimens were pathogenic bacteria cultured,and the antibiotic susceptibility test was carried out. The results were statistically analyzed. According to the results of drug sensitivity of lung cancer after chemotherapy,362 cases of pulmonary infection were randomly divided into the observation group of 192 cases and control group of 170 cases,the observation group were given cefoperazone sulbactam sodium,and control group were given ampicillin. Results The positive strain（ according to common degree）,before and after the chemotherapy,were Candida albicans,pneumonia,et al,with no significant difference（ Z =- 0. 005,P = 0. 996）. Before chemotherapy,after the main sensitive antibiotics were cefoperazone / shubatan,ceftazidime,with no significant difference in their sensitivity. Ampicillin,imipenem and levofloxacin resistance increased after chemotherapy（ P〈0. 05）,cefazolin resistance decreased（ P〈0. 05） after chemotherapy. The efficiency of patients in observation group with cefoperazone sulbactam sodium anti-infection therapy was 92. 2%,and control group with ampicillin treatment was58. 2%,with significant difference（ P〈0. 05）. Total improvement rate of X-ray in observation group was 93. 3% was better than that in control group（ 60. 6%）,with significant difference（ P〈0. 05）. The double infection and adverse reaction rates showed no difference in two groups. Conclusion The spectrum of bacteria in patients with advanced lung cancer before and after chemotherapy of lung infection dosen ＇t change significantly. The chemotherapy has little effect on major sensitive antibiotic sensitivity. The efficacy of cefoperazone and sulbactam sodium in treatment of pulmonary infection of lung cancer after chemotherapy is satisfied,side effect is small.