鼻咽癌患者放疗中发生医院感染的危险因素分析  

Risk factors for nosocomial infections in patients with nasopharyngeal carcinoma during radiotherapy

作　　者：李文杰[1] 杨志林[1] 张艳萍[1] 

机构地区：[1]安阳市人民医院耳鼻喉头颈外科,河南安阳455000

出　　处：《中华医院感染学杂志》2014年第13期3307-3308,3311,共3页Chinese Journal of Nosocomiology

基　　金：国家自然科学基金资助项目(30900309)

摘　　要：目的分析鼻咽癌患者放疗中发生医院感染的危险因素,为临床治疗策略的制定提供参考。方法回顾性分析2011年3月-2013年3月行放疗的72例鼻咽癌患者临床资料,统计其医院感染的发生率、感染部位、病原菌的分布及其危险因素;所有数据采用SPSS 17.0软件进行统计分析。结果 72例鼻咽癌患者中有57例发生医院感染,感染率为79.17%;感染部位以口腔黏膜感染最多36例占63.16%,其次是皮肤感染13例占22.81%;检出病原菌57株,以真菌为主38株占66.67%,其次革兰阴性菌13株占22.80%、革兰阳性菌6株占10.53%,检出病原菌前3位依次为白色假丝酵母菌、鲍氏不动杆菌、热带假丝酵母菌,分别占50.88%、10.53%、8.77%;高龄、接受手术治疗、住院〉30d、应用抗菌药物≥2种以及Ⅲ～Ⅳ期鼻咽癌是鼻咽癌患者放疗中发生医院感染的危险因素。结论鼻咽癌患者容易发生口腔黏膜部的感染,以真菌感染为主,临床上应缩短患者的住院天数,规范进行抗感染治疗,及早发现和控制感染,以减少医院感染的发生,提高患者的临床疗效。OBJECTIVE To analyze the risk factors for nosocomial infections in patients with nasopharyngeal carci- noma during radiotherapy so as to provide guidance for clinical treatment. METHODS From Mar 2011 to Mar 2013, the clinical data of 72 patients with nasopharyngeal carcinoma who underwent the radiotherapy were retrospective- ly analyzed, then the incidence of nosocomial infections, infection sites, distribution of pathogens, and risk factors were taken for statistics, and the statistical analysis of all the data was performed with the use of SPSS 17.0 soft- ware. RESULTS The nosocomial infections occurred in 57 of 72 nasopharyngeal carcinoma patients with the infec- tion rate of 79.17%, among which there were 36 （63.16%） cases of oral mucosa infections and 13 （22.81%） cases of skin infections. Totally 57 strains of pathogens have been isolated, including 38 （66.67 %） strains of fun- gi, 13 （22.80%） strains of gram-negative bacteria, and 6 （10.53%） strains of gram-positive bacteria; the Candi- da albicans, Acinetobacter baumannii, and Candida tropicalis ranked the top three species of pathogens, account- ing for 50. 88%, 10. 53%, and 8. 77%, respectively. The advanced age, surgical procedures, length of hospital stay more than 30 days, use of no less than 2 types of antibiotics, and stage Ⅲ-Ⅳ nasopharyngeal carcinoma were the risk factors for nosocomial infections in the nasopharyngeal carcinoma patients during the radiotherapy. CONCLUSION The nasopharyngeal carcinoma patients are susceptible to the oral mucosa infections, among which the fungal infections are dominant. It is necessary for the hospital to shorten the length of hospital stay, standard- ize the anti-infection treatment, and monitor and control the infection in early stage so as to reduce the incidence of nosocomial infections and improve the clinical efficacy.

关 键 词：鼻咽癌 放疗 医院感染 危险因素 

分 类 号：R379.62[医药卫生—病原生物学]