老年肺癌病人化疗期间院内肺部感染危险因素的病例对照研究

A case-control study on risk factors of nosocomial pulmonary infection during chemotherapy for lung cancer in elderly

目的探讨老年肺癌病人化疗期间发生院内肺部感染的危险因素。方法应用病例对照研究的方法,收集2016年7月至2019年12月徐州医科大学附属宿迁医院呼吸与危重症医学科化疗期间发生院内肺部感染的98例老年肺癌病人为病例组,同期按相同肺癌化疗周期数1∶1配对选取化疗期间未发生肺部感染的98例老年肺癌病人为对照组。比较病例组与对照组间年龄、性别、基础疾病、病理类型、肺癌分期、化疗时机,以及有无支气管镜检查史、气道内致病菌定植、联合放疗、联合免疫治疗、联合抗血管生成药物、中性粒细胞减少、其他部位感染、化疗间期抗生素使用的差异,分析老年肺癌病人化疗期间合并院内肺部感染的危险因素。结果老年肺癌化疗期间院内感染发生率为19.1%(98/513)。单因素分析显示,年龄≥70岁、合并基础疾病、气道内致病菌定植、肺小细胞癌、肺癌Ⅲ~Ⅳ期、后线化疗、联合放疗、中性粒细胞减少和出现其他部位感染与化疗期间发生院内肺部感染有关(P<0.05)。多因素二元Logistic回归分析表明,年龄≥70岁、气道内致病菌定植、肺小细胞癌、联合放疗和中性粒细胞减少是肺癌病人发生院内肺部感染的独立危险因素(P<0.05)。结论老年肺癌化疗期间院内肺部感染发生率较高,危险因素多,应针对相关危险因素采取积极的措施加强预防。

Objective To investigate the risk factors of nosocomial pulmonary infection during chemotherapy for lung cancer in the elderly.Methods A total of 98 patients who presented with nosocomial pulmonary infection during chemotherapy in the Department of Respiratory and Critical Care Medicine of the Affiliated Suqian Hospital of Xuzhou Medical University from July 2016 to December 2019 were selected as the case group,and 98 patients treated with the same number of chemotherapy cycles who did not suffer from pulmonary infection were adopted as the control group.The age,gender,pathological type and other factors were compared between the case group and the control group,and the risk factors of nosocomial pulmonary infection during chemotherapy were analyzed.Results Univariate Logistic regression analysis showed that age≥70 years old,complicated with underlying diseases,colonization of pathogenic bacteria in airway,small cell lung cancer,lung cancer at stageⅢ-Ⅳ,posterior chemotherapy,combined with radiotherapy,neutropenia and infection in other sites were associated with nosocomial pulmonary infection during chemotherapy(P<0.05).Binary Logistic regression analysis showed that age≥70 years,colonization of pathogenic bacteria in airway,small cell lung cancer,combined with radiotherapy and neutropenia were the independent risk factors for nosocomial pulmonary infection during chemotherapy in the elderly patients with lung cancer(P<0.05).Conclusions The incidence of nosocomial pulmonary infection during chemotherapy in the elderly patients with lung cancer is high,and there are many risk factors.Therefore,active measures should be taken to strengthen the prevention of relevant risk factors.