鼻咽癌患者放疗与放化疗医院感染分析

Analysis of hospital infections in nasopharyngeal carcinoma patients with radiotherapy and chemoradiotherapy

目的对鼻咽癌单纯放疗与放化疗患者发生医院感染进行调查分析,为临床治疗防治鼻咽癌感染提供参考依据。方法选择2012-2013年412例在医院接受治疗的患者,将其中150例鼻咽癌发生医院感染患者作为研究对象,分别予以不同治疗方式,其中单纯放疗40例、同期放化疗82例、诱导化疗28例,对比发生感染患者的感染部位与病原菌分布。结果放化疗患者的感染率为53.66%,显著高于单纯放疗的10.00%及诱导化疗的32.14%,差异均有统计学意义(P<0.05);诱导化疗患者的感染率亦高于单纯放疗患者的感染率,差异有统计学意义(P<0.05);患者感染部位在口腔、咽部黏膜占82.67%,显著高于(支)气管、肺部、泌尿系以及肠道等部位的8.00%、6.00%、2.00%、1.33%,差异均有统计学意义(P<0.05);150例感染患者共分离出153株病原菌,其中真菌所占比例最高,为43.79%,显著高于其他病原菌;鲍氏不动杆菌、肺炎克雷伯菌及大肠埃希菌的分布亦较高,分别占20.91%、19.61%及12.42%。结论鼻咽癌患者行单纯放疗及联合放化疗时,应积极关注其感染,及时送检分泌物标本,根据所得结果合理用药。

OBJECTIVE To investigate and analyze the hospital infections caused by single radiotherapy or combined chemoradiotherapy in patients with nasopharyngeal carcinoma so as to provide information and references in accordance with the infections.METHODS From 2012 to 2013,totally 150 cases of patients infected in hospital were chosen as study objects and treated with different ways of therapies.Among them,40 cases received simple radiotherapy,82 cases received concurrent chemoradiotherapy,and another 28 cases received inducing chemotherapy.The infection sites and bacterial distribution were compared.RESULTS The infection prevalence in the same period of patients received radiotherapy and chemotherapy was 53.66%,which was significantly higher than those only received radiotherapy with the rate of 10.00% and those adopted inducting chemotherapy＇s 32.14%.The differences were significant（P〈0.05）.Meanwhile infection prevalence of those received inducting chemotherapy was also higher than those with radiotherapy alone,and the difference was significant（P〈0.05）.Totally 82.67% of the infection sites were in the mouth and pharyngeal mucosa of,which was significantly higher than that in（branch）trachea（8.00%）,lungs（6.00%）,intestines（1.33%）and other parts of the urinary tract（2.00%）.The differences were significant（P〈0.05）.Totally 153 strains of pathogens were isolated from the 150 infected cases.Fungi dominated the majority with the rate of 43.79%,significantly higher than other types of pathogens.Acinetobacter baumannii,Klebsiella pneumoniae and Escherichia coli also had high proportions of 20.91%,19.61% and 12.42% respectively.CONCLUSIONSpecial attention must be paid on the infections caused by radiotherapy and chemoradiotherapy,when treating nasopharyngeal carcinoma patients.Secretion samples should be inspected timely and drugs should be chosen carefully according to inspection results.