头颈部肿瘤放化疗期间并肺部感染的临床分析

Pulmonary infection in patients with head and neck neoplasms during chemotherapy or radiotherapy: a clinical investigation

目的调查分析头颈部肿瘤放化疗期间并肺部感染的情况,探讨有效的防治措施。方法回顾性分析头颈部肿瘤患者712例于放疗或化疗期间并肺部感染的发生率、病原学及治疗转归。结果 712例患者中发生肺部感染30例(4.21%)。共分离病原菌38株,革兰阴性菌33株,占86.84%,革兰阳性菌5株,占13.16%;有多重耐药菌22株。革兰阴性菌耐药现象多见,对青霉素类、第一二代头孢类抗菌药物耐药高,部分高达70%以上,对大部分三代头孢类、碳青霉烯类耐药率0~3.57%。8例患者出现暂停放疗或延长住院时间,2例无法继续抗肿瘤治疗,3例出现感染相关性死亡;3例于出院后3~18个月死于局部肿瘤未控或复发。结论头颈部肿瘤放化疗期间并肺部感染以革兰阴性菌为主,耐药现象普遍;并肺部感染是一个严重的并发症;于放化疗期间应注意防治放射性黏膜炎,避免食物误吸入气道、预防白细胞计数下降、重视营养支持治疗。

Objective To investigate the status of pulmonary infection during radiotherapy and chemotherapy for head and neck cancers and explore effective prevention and control measures. Methods A retrospective survey of 712 cases of head and neck cancer patients during chemotherapy or radiotherapy the incidence of pulmonary infection,etiology and prognosis. Results A total of 38 pathogenic bacteria were isolated,33 were Gram-negative bacteria,accounting for 86. 84%,and 5 were Gram-positive bacteria,accounting for 13. 16%. There are 22 multi-drug resistant bacteria. The resistance to Gram-negative bacteria is more common,and the resistance to penicillins and first-and second-generation cephalosporins is high,and some are as high as more than 70%. The resistance rate to most third-generation cephalosporins and carbapenems is 0 ~3. 57%. Eight patients had pausing radiotherapy or prolonged hospital stay. Two patients could not continue antitumor therapy. Three patients had infection-related deaths. Three patients died of local tumor recurrence or recurrence 3 to 18 months after discharge. Conclusion Gram-negative bacteria are the most common bacteria in Pulmonary infection during head and neck radiotherapy or chemotherapy,drug resistance phenomenon; and pulmonary infection is a serious complication; we should pay attention to the prevention and control of radioactive mucositis during radiotherapy or chemotherapy,avoid food aspiration into the airway,prevent the decrease of white blood cells,and pay attention to nutrition support treatment.