中心型肺癌并发阻塞性肺炎的病原学特点及药物介入治疗的疗效  

Characteristics of infections in central lung cancer patients complicated with obstructive pneumonia and efficacy of drug interventional therapy

作　　者：陈慧冬[1] 詹枝华[1] 沈力[1] 康亮[1] 张定宇[2] 

机构地区：[1]武汉市医疗救治中心呼吸病介入诊疗科,湖北武汉430022 [2]武汉市医疗救治中心麻醉科,湖北武汉430022

出　　处：《中华医院感染学杂志》2017年第17期3871-3874,共4页Chinese Journal of Nosocomiology

基　　金：武汉市卫生与计划生育委员会科研基金资助项目(WG16C10)

摘　　要：目的探讨中心型肺癌并发阻塞性肺炎患者病原菌分布及耐药性,并对药物治疗后疗效进行观察,为临床诊断治疗提供决策依据。方法选取2012年1月-2016年3月医院住院治疗的89例中心型肺癌并发阻塞性肺炎患者,采集患者痰液标本进行培养鉴定,观察病原菌分布及药敏试验结果;按治疗方式将患者分为对照组36例与观察组53例,对照组给予单纯支气管灌注治疗,观察组在对照组治疗基础上同时采用敏感抗菌药物进行灌注治疗,比较两组患者的临床疗效。结果痰培养共分离病原菌211株,其中革兰阴性菌124株占58.77%;革兰阳性菌51株占24.17%;真菌36株占17.06%;排前5位的病原菌依次为肺炎克雷伯菌、铜绿假单胞菌、白假丝酵母、金黄色葡萄球菌及凝固酶阴性葡萄球菌,分别占22.22%、19.91%、12.32%、11.37%、9.95%;肺炎克雷伯菌对亚胺培南及美罗培南最敏感,金黄色葡萄球菌对万古霉素及呋喃妥因最敏感,敏感率均达100.00%;而白假丝酵母对两性霉素B最敏感,敏感率为100.00%;观察组治疗总有效率为94.34%,显著高于对照组的83.33%,两组比较差异有统计学意义(P<0.05)。结论支气管动脉化疗药物灌注术治疗过程中同时灌注抗肿瘤药物与敏感抗菌药物,是治疗中心型肺癌合并阻塞性肺炎的理想治疗方法。OBJECTIVE To explore the distribution and drug resistance of pathogens isolated from the central lung cancer patients complicated with obstructive pneumonia and observe the efficacy of drug interventional therapy so as to provide guidance for clinical diagnosis and treatment.METHODS A total of 89 central lung cancer patients complicated with obstructive pneumonia who were hospitalized for treatment from Jan 2012 to Mar 2016 were enrolled in the study.The sputum specimens were collected for bacterial culture and identification,the distribution of pathogens and result of drug susceptibility testing were observed,the enrolled patients were divided into the observation group with 53 cases and the control group with 36 cases according to the treatment mode.The control group was given single bronchial perfusion therapy,the observation group was treated with sensitive antibiotics for perfusion therapy on the basis of the treatment of the control group,and the clinical therapeutic effects were observed and compared between the two groups of patients.RESULTS Totally 211 strains of pathogens were isolated from the sputum specimens,of which 58.77%（124 strains）were gram-negative bacteria,24.17%（51 strains）were gram-positive bacteria,and 17.06%（36 strains）were fungi.Klebsiella pneumoniae,Pseudomonas aeruginosa,Candida albicans,Staphylococcus aureus and coagulse-negative Staphylococcus ranked the top 5 species of pathogens,accounting for 22.22%,19.91%,12.32%,11.37%and 9.95%,respectively.The K.pneumoniae strains were most susceptible to imipenem and meropenem,the S.aureus strains were most susceptible to vancomycin and nitrofurantoin,with the drug susceptibility rate 100.00%,and the C.albicans strains were most susceptible to amphotericin B,with the drug susceptibility rate 100.00%.The total effective rate of treatment of the observation group was 94.34%,significatly higher than 83.33%of the control group（P〈0.05）.CONCLUSION The bronchial artery perfusion of chemotherapy drugs combined with perfusion of antitum

关 键 词：中心型肺癌 阻塞性肺炎 支气管灌注治疗 

分 类 号：R563.1[医药卫生—呼吸系统]