头颈部肿瘤患者放疗期间口咽细菌感染风险增加的护理研究

Nursing Research on the Increased Risk of Oropharynx Bacteria Infection in Head and Neck Cancer Patients Treated with Radiotherapy

目的探讨头颈部肿瘤患者放疗期间口咽部细菌感染风险的相关因素及护理干预措施。方法选择2013年5月-2014年5月我科收治的122例头颈部肿瘤患者放疗期间的咽拭子细菌培养结果进行分析，有序Logistic多因素回归模型探讨感染菌种数的相关影响因素。结果放疗期间晒拭子细菌阳性患者60例，占49．2％。50例检测到一种细菌，9例检测到2种细菌，1例检测到3种细菌。最多见的细菌为金葡菌，其次为肺炎克雷伯菌、鲍曼不动杆菌、阴沟长杆菌、铜绿假单胞菌等。多因素分析结果显示，使用西妥昔单抗、年龄及T分期是影响口腔感染菌种数量的显著因素。结论使用西妥昔单抗，年龄及T分期可能增加头颈部肿瘤患者放疗期间口咽部多重感染的风险。针对感染高危患者应采取相应的护理措施。

Objective To analyze whether radiotherapy combined with cetuximab correlates with increased risk of bacteria infection in head and neck cancer patients and to explore the nursing countermeasures for radiation-induced oral mucositis. Methods The throat swab specimens were obtained from 122 head and neck patients during IMRT course at our hospital from may 2013 to may 2014. The clinically relevant factors for the bacteria-positive throat swab cultures were evaluated for their predictive effect using the ordered logistic regression. Results A total of 60 cases （49.2%） presented positive results of throat swab cultures for pathogenic bacteria during radiotherapy course. One type of bacteria was detected in 50 cases, two types in 9 cases, and three types in 1 case. The most common type of pathogenic bacteria was staphylococcus aureus, followed by klebsiella pneumoniae, baumanii, bacillus cloacae and pseudomonas aeruginosa. Age, T stage and administration of cettiximab were found to be the most significant predictors for oral and pharyngeal bacteria infection. Conclusions Older age, advanced T stage and the usage of cetuximab can significantly increase the risk of oropharynx bacteria infection in head and neck cancer patients during radiotherapy. The corresponding nursing countermeasures need to be taken for patients with high risk of developing radiation-induced bacterial oral mucositis.