消化道肿瘤术后放化疗期间真菌感染的临床特征与防护措施  

Clinical characteristics and protective measures of fungal infection during postoperative chemoradiotherapy for abdominal tumors

作　　者：张艳 王卉 龙小丽 ZHANG Yan;WANG Hui;LONG Xiaoli(Radiotherapy Department,the First Affiliated Hospital of Air Force Military Medical University,Xi'an 710032,Shaanxi,China)

机构地区：[1]空军军医大学第一附属医院放疗科,陕西西安710032

出　　处：《中国现代手术学杂志》2024年第4期339-343,共5页Chinese Journal of Modern Operative Surgery

基　　金：空军军医大学第一附属医院重点学科助推计划项目(XJHLD22D206)。

摘　　要：目的探讨消化道肿瘤切除术后放化疗患者真菌感染的临床特征及防护措施,为临床预防和治疗提供科学依据。方法选取空军军医大学第一附属医院放疗科2021年1月至2023年1月收治的消化道肿瘤切除术后放化疗患者1045例,通过对患者血液、痰液及尿液检测,分析真菌感染分布特征、感染率、耐药情况、感染部位及防护措施。结果1045例消化道肿瘤术后放化疗患者中,发生真菌感染96例,感染率为9.19%,其中6例患者为多重感染,共培养出102株真菌病原菌,以白色假丝酵母菌及光滑假丝酵母菌为主,构成比分别为38.24%与31.37%;其次为热带假丝酵母菌(14.71%)、克柔假丝酵母菌(8.82%);啤酒酵母菌及放线菌较少,分别为3.92%与2.94%。96例真菌感染患者的感染部位主要为呼吸道(53.12%)、泌尿系统(29.17%)及口腔(15.62%),针对感染部位实施具体防治措施,效果显著。培养出的102株真菌对临床中常用的酮康唑、咪康唑的耐药率较高,而临床上较少使用的伊曲康唑对上述6种真菌耐药率均较低。结论消化道肿瘤切除术后放化疗患者真菌感染以白色假丝酵母菌及光滑假丝酵母菌为主,感染部位主要集中在呼吸道、泌尿系统及口腔等处。临床工作中应采取有效干预措施,依据药敏试验结果指导临床用药,并对主要感染部位重点关注及有效监测、护理,以降低真菌感染发生率。Objective To explore the clinical characteristics and protective measures of fungal infections in patients undergoing postoperative chemoradiotherapy for abdominal tumors.Methods A total of 1045 patients with chemoradiotherapy after resection of abdominal tumors from January 2021 to January 2023 were selected from the Radiotherapy Department of the First Affiliated Hospital of Air Force Military Medical University.The distribution characteristics,infection rate,drug resistance,infection site and protective measures of fungal infection were analyzed by detecting the patients'blood,sputum and urine.Results Among the 1045 patients,there were 96 cases developed fungal infections,with an infection rate of 9.19%.Among them,6 patients developed multiple infections.And a total of 102 fungal pathogens were cultured,mainly composed of Candida albicans and Candida glabrata,with composition ratios of 38.24%and 31.37%,respectively;Next were Candida tropicalis(14.71%)and Candida krusei(8.82%);The fewer ones were Saccharomyces cerevisiae and Actinomycetes,accounting for 3.92%and 2.94%,respectively.The infection sites of 96 fungal infection patients were mainly located in respiratory tract(53.12%),urinary system(29.17%),and oral cavity(15.62%).Specific prevention and treatment measures targeting the infected area were effective.The 102 strains of fungi cultivated had a high resistance rate to commonly used ketoconazole and miconazole in clinical practice,while itraconazole,which was less commonly used in clinical practice,had a low resistance rate to the six types of infectious fungi.Conclusion Fungal infections in patients undergoing chemo radiotherapy after abdominal tumor resection are mainly caused by Candida albicans and Candida glabrata.The infection sites are mainly concentrated in the respiratory tract,urinary system,and oral cavity.Effective intervention measures should be taken in clinical work,and clinical medication should be guided based on drug sensitivity test results.Key attention and effective monitoring and nur

关 键 词：消化道肿瘤 真菌感染 放化疗 微生物检测 耐药性 防护 

分 类 号：R735[医药卫生—肿瘤] R519[医药卫生—临床医学]