咽拭子培养干预对鼻咽癌适形调强放疗放射性口腔黏膜炎治疗的临床研究  

Clinical study of pharyngeal swab culture intervention in the treatment of radioactive oral mucositis induced by intensity-modulated radiotherapy for nasopharyngeal carcinoma

作　　者：李能平[1] 林秀芳[1] 梁文胜[1] 冯庆[1] 柯柳杨[1] 朱的霞 黄瑞文[1] LI Nengping;UN Xiufang;LIANG Wensheng(Department of Radiotherapy,Guangdong Provincial Nongken Central Hospital,Guangdong Province,Zhanjiang 524002,China)

机构地区：[1]广东省农垦中心医院放疗二区,广东省湛江市524002

出　　处：《临床合理用药杂志》2020年第7期29-30,32,共3页Chinese Journal of Clinical Rational Drug Use

基　　金：湛江市非资助科技攻关计划项目(No:2016B01087).

摘　　要：目的观察咽拭子培养在应用抗生素治疗放射性口腔黏膜炎中的临床价值。方法选取2016年4月-2018年11月在广东省农垦中心医院治疗的鼻咽癌患者117例,因药物过敏中途退出2例。采用随机数字表法分为观察组58例和对照组57例。2组均采用同样的放化疗方案,出现放射性口腔黏膜炎时,观察组治疗前行咽拭子检查,然后再根据结果应用抗生素治疗,对照组治疗前不行咽拭子培养检查,2组治疗后均再行咽拭子培养,对比2组患者使用抗生素治疗前后疼痛评分及口腔黏膜炎症变化等情况,观察咽拭子培养的作用。结果2组咽拭子培养阳性45例(39.13%),观察组58例,咽拭子阳性29例(50.00%),此29例按药敏试验予敏感抗生素治疗。对照组57例,咽拭子培养阳性16例(28.07%),57例均按经验予抗生素治疗。使用抗生素后,观察组放射性口腔黏膜炎分级情况优于对照组(P<0.05)。观察组对疼痛的控制明显优于对照组(P<0.05)。对照组用药后咽拭子培养阳性16例,产生耐药7例,明显高于观察组,2组使用抗生素后的咽拭子培养差异有统计学意义(P<0.05)。结论鼻咽癌调强放疗中放射性口腔黏膜炎的发生率为100%,合并感染者常见,使用抗生素治疗前行咽拭子培养对选择合适的抗生素抗感染治疗有很好的指导作用,且对感染控制效果优于经验性用药,操作简单,适用性强,值得推广使用。Objective To observe the clinical value of pharyngeal swab culture in the treatment of radioactive oral mucositis with antibiotics.Methods A total of 117 patients with nasopharyngeal cancer who were treated at Guangdong Provincial Nongken Central Hospital from April 2016 to November 2018 were selected.Two patients withdrew due to drug allergies.Random number table method was used to divide the observation group into 58 cases and the control group into 57 cases.Both groups were treated with the same radiotherapy and chemotherapy regimen.In the case of radioactive oral mucositis,pharynx swabs were examined before treatment in the observation group,and then antibiotics were used according to the results.The control group had no pharynx swab culture examination before treatment,and both groups underwent pharynx swab culture after treatment.The pain score and the changes of oral mucosal inflammation were compared between the two groups before and after antibiotic treatment,and the effect of pharynx swab culture was observed.Results 45 cases of pharyngeal swab culture were positive in the two groups(39.13%).58 cases in observation group and 29 cases in pharynx swab positive(50.00%).These 29 cases were treated with sensitive antibiotics according to drug sensitivity test.57 cases in the control group and 16 cases with positive swab culture(28.07%).All 57 cases were treated with antibiotics according to experience.After used antibiotics,the grade of radiation oral mucositis in the observation group was better than that in the control group(P<0.05).The observation group had significantly better pain control than the control group(P<0.05).In the control group,16 cases of pharyngeal swab culture were positive after treatment,and 7 cases had drug resistance,which was significantly higher than that of the observation group,the differences in pharyngeal swab culture after antibiotic administration in the two groups were statistically significant(P<0.05).Conclusion The incidence of radiation oral mucositis in intensity-modulate

关 键 词：咽拭子培养 鼻咽癌 放射治疗 放射性口腔黏膜炎 

分 类 号：R730.55[医药卫生—肿瘤] R739.63[医药卫生—临床医学]