鼻咽癌患者放疗期医院感染的危险因素分析及预防对策  

Risk factors of nosocomial infections during radiotherapy in patients with nasopharyngeal carcinoma and its prevention measures

作　　者：高琳[1] 陆贞[2] 高笙刚 张清[1] 汪德清[3] 谭翠莲[3] 陈聪[3] 马立翠[3] 

机构地区：[1]湖北医药学院附属随州医院肿瘤放疗科,湖北随州441300 [2]湖北医药学院附属随州医院急诊医学科,湖北随州441300 [3]湖北医药学院附属随州医院耳鼻喉科,湖北随州441300

出　　处：《中华医院感染学杂志》2017年第11期2565-2568,共4页Chinese Journal of Nosocomiology

基　　金：湖北省卫计委面上基金资助项目(JX6B128)

摘　　要：目的探究鼻咽癌患者放疗期间医院感染的危险因素并依据患者医院感染的相关危险因素采取相应的预防对策。方法选择2013年1月-2015年10月医院收治200例经病理诊断确诊的鼻咽癌患者为研究对象,分析患者感染的致病菌分布,并对其发生医院感染的相关因素进行单因素及多因素分析,其中多因素分析采用logistic回归分析。结果 200例鼻咽癌患者中,放射治疗后共157例患者发生医院感染,感染率为78.5%;患者感染部位中主要以口腔感染为主占64.3%;感染患者共分离出病原菌184株,而病原菌中主要以真菌为主127株占69.0%,革兰阴性菌40株占21.7%,革兰阳性菌17株占9.3%;多因素logistic回归分析显示,患者年龄≥60岁,常规放疗、同步化疗、相关侵入性操作、肿瘤分期高、抗菌药物≥2种以及免疫抑制剂使用情况是鼻咽癌患者放疗期发生医院感染的独立危险因素(P<0.05)。结论鼻咽癌患者在医院治疗期部分患者因发生感染,对其治疗和预后有着严重影响,因此详细了解鼻咽癌患者放疗期医院感染的好发部位、病原菌种类以及导致感染的相关危险因素,对于指导临床依据病原菌分布和其耐药情况给予合理抗菌药物治疗有着重要意义;同时依据导致患者发生医院感染的危险因素进行预防,可在一定程度上降低医院感染率的发生,值得临床推广。OBJECTIVE To explore the risk factors of nosocomial infections during radiotherapy in nasopharyngeal carcinoma patients and take corresponding preventive measures according to the related risk factors of nosocomial infections.METHODS A total of 200 patients with nasopharyngeal carcinoma diagnosed by pathology from Jan.2013 to Oct.2015 were enrolled in this study.The distribution of pathogenic bacteria in patients with infection was analyzed.The relevant factors of nosocomial infection were analyzed by univariate analysis and multivariate a nalysis,and multivariate analysis was performed using logistic regression analysis.RESULTS A total of 157 patients with nasopharyngeal carcinoma after radiotherapy occurred nosocomial infection,with the infection rate of 78.5%.The main infection site in patients was oral infection,accounting for 64.3%.A total of 184 strains of pathogens were isolated,and pathogens were mainly 127 strains of fungi,accounting for 69.0%.There were 40 strains of gram-negative bacteria,accounting for 21.7%,and 17 strains of gram positive bacteria,accounting for 9.2%.The multivariate logistic regression analysis showed that,the age of patients≥60 years old,conventional radiotherapy,synchronous chemotherapy,related invasive operation,high tumor stage,antibiotics ≥2 and the use of immunosuppressant were independent risk factors for nosocomial infections in patients with nasopharyngeal carcinoma during radiotherapy （P〈0.05）.CONCLUSION The infection in some nasopharyngeal carcinoma patients in the hospital during the treatment has serious influence on its treatment and prognosis,so a detailed understanding of the main infection sites,pathogenic bacteria species and the related risk factors of nosocomial infections in nasopharyngeal carcinoma patients during radiotherapy has important significance to guide the rational use of antibiotics according to the pathogens distribution and their drug resistance.At the same time,certain preventive measures based on risk factors of nosocomial infections ca

关 键 词：鼻咽癌 放疗 医院感染 危险因素 预防对策 

分 类 号：R739.6[医药卫生—肿瘤]