直肠癌术后患者放疗期间并发感染的病原菌分布及影响因素分析  

Distribution of pathogens and influencing factors of combined infection in patients after rectal cancer operation during radiotherapy

作　　者：刘明[1] 张辛[1] 王硕烁 张瑞[1] 吕冬婕[1] LIU Ming;ZHANG Xin;WANG Shuoshuo;ZHANG Rui;LYU Dongjie(Department of Radiotherapy,the Fourth Hospital of Hebei Medical University,Shijiangzhuang,Hebei,050011)

机构地区：[1]河北医科大学第四医院放疗科,河北石家庄050011

出　　处：《实用临床医药杂志》2021年第20期78-80,84,共4页Journal of Clinical Medicine in Practice

摘　　要：目的观察直肠癌术后放疗期间并发感染的病原菌分布情况,并分析患者发生感染的影响因素。方法回顾性分析500例直肠癌患者的临床资料,患者术前均接受辅助放化疗,之后接受根治性切除术,并于术后1个月接受放化疗。统计患者放化疗期间感染发生情况和病原菌分布情况,分析患者医院感染的影响因素。结果500例直肠癌患者术后放化疗期间发生医院感染49例,感染率为9.80%。49例医院感染者共培养出病原菌62株,其中革兰阴性菌包括大肠埃希菌、铜绿假单胞菌、鲍曼不动杆菌等占比最高,未检出真菌。Logistic回归分析结果显示,Ⅲ期肿瘤、合并糖尿病、白细胞计数低、预防性抗菌药物使用种类多均是直肠癌术后放疗患者医院感染的影响因素(OR>1,P<0.05)。结论革兰阴性菌是直肠癌术后放疗期间医院感染的主要病原菌,肿瘤分期高、合并糖尿病、白细胞计数降低、预防性抗菌药物使用种类多可能是导致患者放疗期间感染的影响因素,应引起临床重视。Objective To observe the distribution of pathogens of combined infection in patients after rectal cancer operation during radiotherapy,and to analyze the influencing factors of infection.Methods The clinical data of 500 patients with rectal cancer was retrospectively analyzed,all patients received adjuvant chemoradiotherapy before operation,then received radical resection,and received chemoradiotherapy 1 month after operation.The incidence of infection and the distribution of pathogenic bacteria during radiotherapy and chemotherapy were analyzed,and the influencing factors of nosocomial infection were analyzed.Results In 500 patients with rectal cancer,49 cases had nosocomial infection during chemoradiotherapy after operation,the infection rate was 9.80%.A total of 62 strains of pathogens were isolated from 49 patients with nosocomial infection,the proportions of Gram-negative bacteria including Escherichia coli,Pseudomonas aeruginosa,Acinetobacter baumannii and so on were the highest,no fungus was detected.Logistic regression analysis showed that tumors in stageⅢ,combining with diabetes mellitus,low white blood cell count and various prophylactic antibiotics used were the influencing factors of nosocomial infection in patients with radiotherapy after rectal cancer operation(OR>1,P<0.05).Conclusion Gram-negative bacteria are the main pathogens of nosocomial infection during radiotherapy after rectal cancer operation,high tumor stage,combining with diabetes mellitus,low white blood cell count and various prophylactic antibiotics used may be the influencing factors of infection during radiotherapy.Therefore,the situations should be emphasized in clinic.

关 键 词：直肠癌 根治术 放疗 医院感染 病原菌分布 糖尿病 

分 类 号：R619[医药卫生—外科学] R7355.3[医药卫生—临床医学]