老年肺癌放疗患者医院感染因素与预防

Factors and prevention of hospital infections in elderly patients with lung cancer radiotherapy

目的探讨老年肺癌放疗患者医院感染危害因素及防治策略,以降低老年肺癌放疗患者医院感染率。方法选择2013年6月-2015年6月在医院接受放疗的468例老年肺癌患者,采集感染患者标本进行细菌培养、鉴定及药敏实验,并对老年放疗患者医院感染的相关因素进行分析。结果 468例患者发生感染96例,感染率为20.51%,感染部位以上呼吸道感染为主,感染率为36.46%,其次为下呼吸道感染,感染率为27.08%;从96例感染患者送检标本中共分离出202株病原菌,其中革兰阳性菌占34.16%;革兰阴性菌占58.91%;真菌占6.93%;经logistic回归分析,年龄≥70岁、合并糖尿病、长期大量吸烟史、住院时间≥25d、TNM分期Ⅳ期、白细胞<4.0×109L、放疗剂量>30Gy、合并肺部疾病、长期抗菌药物使用、侵入性操作、营养状态较差为老年肺癌放疗患者院内感染的独立因素。结论老年肺癌放疗患者医院感染危害因素较多,应根据相关危害因素积极采取对应的防治措施,以降低老年肺癌放疗患者医院感染的发生率。

OBJECTIVE To investigate risk factors and prevention strategies of hospital infections in elderly lung cancer patients treated with radiotherapy,so as to reduce hospital infections in elderly lung cancer patients treated with radiotherapy.METHODS A total of 468 cases of elderly patients with lung cancer from Jun.2013 to Jun.2015 got radiotherapy in hospital.The infected specimens of patients were collected for bacterial culture,identification and sensitivity test.The related factors of hospital infections in elderly patients treated with radiotherapy were analyzed.RESULTS From the 468 patients,96cases got infections,and the infection rate was 20.51%.The infections mainly happened in the upper respiratory tract with infection rate 36.46%,followed by lower respiratory tract infections（27.08%）.From the 96 samples from infected patients,a total of 202 pathogens were isolated,including gram-positive bacteria 34.16%,gram-negative bacteria 58.91%,fungi 6.93%.After logisticregression analysis,age≥70years,diabetes,long-term heavy smoking history,duration of hospitalization ≥25d,TNM staging of Ⅳ,WBC 〈4.0×10^9 L,radiation dose 〉30 Gy,pulmonary disease,long-term use of antibiotics,invasive procedures and poor nutritional status were the independent factors of hospital infections in older lung cancer patients treated with radiotherapy.CONCLUSION There are many risk factors of hospital infections in elderly patients with lung cancer,which should be taken corresponding measures actively,according to the relevant risk factors to reduce the incidence of hospital infections in elderly lung cancer patients treated with radiotherapy.