原发性肝癌患者化疗后抗菌药物的应用及继发感染的危险因素分析

Application of antibiotics and risk factors of secondary infection in patients with primary liver cancer after chemotherapy

目的:探究原发性肝癌患者术后抗菌药物的应用情况,同时分析患者术后继发感染的危险因素,进而控制相关危险因素而降低术后感染的风险。方法:选取采用肝动脉化疗栓塞术(TACE)进行治疗的120例原发性肝癌患者作为研究对象,并根据其术后是否发生感染将其分为感染组(33例)和非感染组(87例)。①记录所研究对象的性别、年龄、体重指数(BMI)、有无吸烟史等一般资料,同时记录患者CTP分级、是否合并肝硬化、是否合并糖尿病、是否存在肝外转移、是否有胸腔积液、肿瘤数目等疾病情况;②术前测定患者血清白蛋白(Alb)、白细胞计数(WBC)、血红蛋白(Hb)水平;③记录术后患者抗菌药物的使用情况;④记录患者术后继发感染的发生情况,并对相关危险因素进行分析。结果:所有原发性肝癌患者在TACE术后共使用386次抗菌药物,其中应用一代头孢菌素243次(62.95%),二代头孢菌素56次(14.51%),三代头孢菌素63次(16.32%),氟喹诺酮类24次(6.22%);术后发生继发感染的患者33例,未感染患者87例,感染率达到27.50%,其中切口感染12例(36.36%),肺部感染6例(18.18%),血流感染5例(15.15%),腹膜炎6例(18.18%),泌尿感染4例(12.12%);Logistic回归分析结果显示,有吸烟史、CTP评分高、合并肝硬化、合并糖尿病、合并肝外转移、有胸腔积液、高水平白细胞计数、低水平血清白蛋白、低水平血红蛋白均是患者术后继发感染的独立危险因素(均P<0.05)。结论:临床上采用TACE术治疗原发性肝癌患者时,需加强抗菌药物的监管,规范抗菌药物的应用。有吸烟史、CTP评分高、合并肝硬化、合并糖尿病、合并肝外转移、有胸腔积液、高水平白细胞计数、低水平血清白蛋白、低水平血红蛋白均是患者术后继发感染发生的独立危险因素,临床上应对以上各因素采取相应的预防措施进行干预,以降低患者术后继发感染的发生率,提高TACE手术治疗的安全性和有效性。

Objective:To explore the application of postoperative antibiotics in patients with primary liver cancer,and to analyze the risk factors of postoperative secondary infection in patients,so as to control the relevant risk factors and reduce the risk of postoperative infection.Methods:A total of 120 patients with primary liver cancer who were treated with TACE were selected and divided into infection group(33 cases)and non-infection group(87 cases)according to whether postoperative infection occurred.General data on sex,age,body mass index(BMI),smoking status,CTP grade,and presence or absence of cirrhosis,presence or absence of diabetes mellitus,presence or absence of extrahepatic metastases,presence or absence of pleural effusions,and number of tumors were recorded.The levels of serum albumin,white blood cell count and hemoglobin were measured before surgery.The use of antibiotics in postoperative patients and the occurrence of postoperative secondary infection were recorded,and the related risk factors were analyzed.Results:All patients with primary liver cancer received a total of 386 antibiotics after TACE,including 243 first-generation cephalosporins(62.95%),56 second-generation cephalosporins(14.51%),63 third-generation cephalosporins(16.32%),and 24 fluoroquinolones(6.22%).There were 33 patients with secondary infection and 87 uninfected patients,the infection rate reached 27.50%,including 12 cases of incision infection(36.36%),6 cases of lung infection(18.18%),5 cases of bloodstream infection(15.15%),6 cases of peritonitis(18.18%),and 4 cases of urinary infection(12.12%).Logistic regression analysis showed that smoking history,high CTP score,liver cirrhosis,diabetes mellitus,extrahepatic metastasis,pleural effusion,high white blood cell count,low serum albumin,and low hemoglobin were all independent risk factors for postoperative secondary infection(all P<0.05).Conclusion:When TACE is used in clinical treatment of patients with primary liver cancer,it is necessary to strengthen the supervision of antibacterial drugs and standardize the application of antibacterial drugs.smoking history,high CTP score,liver cirrhosis,diabetes mellitus,extrahepatic metastasis,pleural effusion,high white blood cell count,low serum albumin,and low hemoglobin were all independent risk factors for postoperative secondary infection.Corresponding preventive measures should be taken clinically to intervene the above factors to reduce the incidence of postoperative secondary infection and improve the safety and effectiveness of TACE surgical treatment.