胸部肿瘤放射性肺损伤患者肺部感染的临床诊治

Clinical diagnosis and treatment of lung infection in patients with radioactive lung injury due to breast tumor

目的探讨胸部肿瘤放射性肺损伤合并肺部感染的诊治策略。方法选择2010年6月-2012年6月医院确诊的64例胸部肿瘤放射性肺损伤患者为研究对象,其中26例合并肺部感染为A组,38例未合并肺部感染为B组,比较分析两组患者诊断资料,探讨临床预防治疗方法。结果 64例经胸片检出率35.94%,CT扫描检出率90.63%,两者比较差异有统计学意义(P<0.05);A组影像学表现多以散在片状浸润性病变为主,B组放疗照射野相关肺野间隔纹理增生或伴局部条状致密影,后期呈纤维化改变;痰培养结果提示,A组患者感染病原菌以革兰阴性菌为主占76.92%,B组未检出病原菌;A组经抗炎、抗感染和对症治疗后症状明显好转,治疗总有效率84.62%,B组经糖皮质激素、对症治疗后治疗总有效率86.84%。结论影像学检查结合痰培养能够对放射性肺损伤合并肺部感染与否做出准确鉴别,抗感染是预防治疗放射性肺损伤合并肺部感染的必要措施。

OBJECTIVE To study the diagnosis and treatment strategy of lung infection complicated with radioactive lung injury in patients with breast tumor .METHODS Totally 64 cases of radioactive lung injury due to breast tumor diagnosed in the hospital during Jun .2010-Jun .2012 were selected as the research subjects ,among whom 26 cases complicated with lung infection were set as group A and 38 cases without lung infection as group B .The comparative analysis was conducted on diagnostic data of the two groups to explore the clinical prevention and con‐trol strategy .RESULTS The detection rate was 35 .94% （64 cases）by chest X‐ray and 90 .63% by CT scan ,which showed significant difference （P〈 0 .05） .Imaging findings were manifested with scattered patchy infiltrates in group A ,and interval hyperplasia related to lung field or local dense strip shade in radiation filed in group B which showed fibrotic changes in late stage .The sputum culture results suggested that group A was predominant with gram‐negative bacteria accounting for 76 .92% ,while there were no pathogenic bacteria found in group B .The symptoms were improved significantly after anti‐inflammatory ,anti‐infective and symptomatic treatments in group A ,and the total effective rate was 84 .61% .The total effective rate was 86 .84% in group B after treatment with corticosteroids .CONCLUSION The sputum culture in combination with imaging examination can accurately differ‐entiate whether lung infection presented in patients with radioactive lung injury and anti‐infective treatment was necessary for prevention and control of radioactive lung injury complicated by lung infection .