食管癌患者食管气管瘘食管粒子支架植入术后肺部感染的研究

发布时间：2018-02-04 18:18

本文关键词： 食管癌食管气管瘘 Ⅰ粒子支架植入术肺部感染病原菌　出处：《中华医院感染学杂志》2017年20期 　论文类型：期刊论文

【摘要】：目的分析食管癌并发食管气管瘘粒子支架植入术后肺部感染的危险因素、病原菌分布,总结术后肺部感染控制措施。方法回顾性分析2010年3月-2016年2月于医院接受食管125Ⅰ粒子支架植入术治疗的220例食管癌并发食管气管瘘患者的临床资料,收集人口学资料、肺功能指标、合并疾病、病理情况、病原菌分布、药敏试验结果等,筛选导致患者术后肺部感染的相关因素,总结防治措施。结果 220例食管癌并发食管气管瘘食管粒子支架植入术患者术后发生肺部感染44例,感染率为20.00%,44例术后并发肺部感染患者,痰培养阳性38例,阳性率为86.36%,共培养病原菌58株,其中革兰阴性菌24株占41.38%,以铜绿假单胞菌为主;革兰阳性菌9株占15.52%,以金黄色葡萄球菌为主;真菌25株占43.10%,以白假丝酵母菌为主;铜绿假单胞菌对头孢吡肟、阿米卡星、环丙沙星、左氧氟沙星较为敏感;肺炎克雷伯菌对头孢吡肟、亚胺培南较为敏感;鲍氏不动杆菌对亚胺培南、妥布霉素、头孢曲松等较为敏感;金黄色葡萄球菌对万古霉素、复方磺胺甲VA唑片较为敏感;白假丝酵母菌对氟康唑、5-氟胞嘧啶、两性霉素B、伊曲康唑均较为敏感;光滑假丝酵母菌对5-氟胞嘧啶、两性霉素B较为敏感;高龄、吸烟、糖尿病、慢性阻塞性肺疾病、手术时间为食管癌并发食管气管瘘粒子支架植入术后肺部感染发生的独立危险因素(P0.05)。结论高龄、长期吸烟史、合并糖尿病、合并慢性阻塞性肺疾病、手术时间过长均可能增加食管癌并发食管气管瘘粒子支架植入术后肺部感染发生,积极控制危险因素,根据药敏试验结果合理应用抗菌药物则可降低肺部感染发生风险,提高感染控制率。
[Abstract]:Objective to analyze the risk factors of pulmonary infection and the distribution of pathogenic bacteria in esophageal carcinoma complicated with esophageal tracheal fistula. Methods from March 2010 to February 2016, 220 cases of esophageal carcinoma complicated with esophageal tracheal fistula were treated with 125i seed stent implantation in hospital from March 2010 to February 2016. The patient's clinical data. To collect demographic data, pulmonary function index, complicated diseases, pathological conditions, pathogenic bacteria distribution, drug sensitivity test results and so on, to screen the related factors leading to postoperative pulmonary infection. Results 44 patients with esophageal cancer complicated with esophageal tracheotracheal fistula and esophageal seed stent implantation had pulmonary infection after operation, and the infection rate was 20.00%. Of the 44 patients complicated with pulmonary infection after operation, 38 were positive in sputum culture, the positive rate was 86.36.The total number of pathogenic bacteria cultured was 58, of which 24 were Gram-negative bacteria (41.38%). Pseudomonas aeruginosa; Gram-positive bacteria accounted for 15.52%, Staphylococcus aureus was the main strain. 25 strains of fungi accounted for 43.10, mainly Candida albicans. Pseudomonas aeruginosa was sensitive to cefepime, amikacin, ciprofloxacin and levofloxacin. Klebsiella pneumoniae was sensitive to cefepime and imipenem. Acinetobacter baumannii was sensitive to imipenem, tobramycin and ceftriaxone. Staphylococcus aureus was sensitive to vancomycin and compound sulfamethazol tablets. Candida albicans were sensitive to fluconazole 5-fluorocytosine, amphotericin B and itraconazole. Candida smooth was sensitive to 5-fluorocytosine and amphotericin B; Old age, smoking, diabetes, chronic obstructive pulmonary disease, the operation time is the independent risk factor of pulmonary infection after esophagotracheal fistula particle stent implantation. Long-term smoking history, diabetes mellitus, chronic obstructive pulmonary disease, long operation time may increase the incidence of pulmonary infection after esophageal carcinoma complicated with esophageal tracheal fistula particle implantation, and actively control the risk factors. The rational application of antimicrobial agents can reduce the risk of pulmonary infection and increase the infection control rate according to the results of drug sensitivity test.
【作者单位】：南阳市第二人民医院肿瘤科;河南科技大学医学院;
【分类号】：R735.1
【正文快照】： 报道显示,约有5%~10%的食管癌患者可能并发食管气管瘘[1]。且食管气管瘘反复发作,可引起营养不良,诱导肺部感染,导致病情恶化,严重者可能发生呼吸衰竭,死亡率高,预后差。放射125Ⅰ粒子支架植入术是目前治疗食管癌并发食管气管瘘的有效方案,其可实现近距离放疗,靶区剂量高,且副

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