本文關(guān)鍵詞： 食管癌 食管氣管瘺 Ⅰ粒子支架植入術(shù) 肺部感染 病原菌　出處：《中華醫(yī)院感染學(xué)雜志》2017年20期 　論文類型：期刊論文

【摘要】：目的分析食管癌并發(fā)食管氣管瘺粒子支架植入術(shù)后肺部感染的危險(xiǎn)因素、病原菌分布,總結(jié)術(shù)后肺部感染控制措施。方法回顧性分析2010年3月-2016年2月于醫(yī)院接受食管125Ⅰ粒子支架植入術(shù)治療的220例食管癌并發(fā)食管氣管瘺患者的臨床資料,收集人口學(xué)資料、肺功能指標(biāo)、合并疾病、病理情況、病原菌分布、藥敏試驗(yàn)結(jié)果等,篩選導(dǎo)致患者術(shù)后肺部感染的相關(guān)因素,總結(jié)防治措施。結(jié)果 220例食管癌并發(fā)食管氣管瘺食管粒子支架植入術(shù)患者術(shù)后發(fā)生肺部感染44例,感染率為20.00%,44例術(shù)后并發(fā)肺部感染患者,痰培養(yǎng)陽性38例,陽性率為86.36%,共培養(yǎng)病原菌58株,其中革蘭陰性菌24株占41.38%,以銅綠假單胞菌為主;革蘭陽性菌9株占15.52%,以金黃色葡萄球菌為主;真菌25株占43.10%,以白假絲酵母菌為主;銅綠假單胞菌對(duì)頭孢吡肟、阿米卡星、環(huán)丙沙星、左氧氟沙星較為敏感;肺炎克雷伯菌對(duì)頭孢吡肟、亞胺培南較為敏感;鮑氏不動(dòng)桿菌對(duì)亞胺培南、妥布霉素、頭孢曲松等較為敏感;金黃色葡萄球菌對(duì)萬古霉素、復(fù)方磺胺甲VA唑片較為敏感;白假絲酵母菌對(duì)氟康唑、5-氟胞嘧啶、兩性霉素B、伊曲康唑均較為敏感;光滑假絲酵母菌對(duì)5-氟胞嘧啶、兩性霉素B較為敏感;高齡、吸煙、糖尿病、慢性阻塞性肺疾病、手術(shù)時(shí)間為食管癌并發(fā)食管氣管瘺粒子支架植入術(shù)后肺部感染發(fā)生的獨(dú)立危險(xiǎn)因素(P0.05)。結(jié)論高齡、長期吸煙史、合并糖尿病、合并慢性阻塞性肺疾病、手術(shù)時(shí)間過長均可能增加食管癌并發(fā)食管氣管瘺粒子支架植入術(shù)后肺部感染發(fā)生,積極控制危險(xiǎn)因素,根據(jù)藥敏試驗(yàn)結(jié)果合理應(yīng)用抗菌藥物則可降低肺部感染發(fā)生風(fēng)險(xiǎn),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.
【作者單位】： 南陽市第二人民醫(yī)院腫瘤科;河南科技大學(xué)醫(yī)學(xué)院;
【分類號(hào)】：R735.1
【正文快照】： 報(bào)道顯示,約有5%~10%的食管癌患者可能并發(fā)食管氣管瘺[1]。且食管氣管瘺反復(fù)發(fā)作,可引起營養(yǎng)不良,誘導(dǎo)肺部感染,導(dǎo)致病情惡化,嚴(yán)重者可能發(fā)生呼吸衰竭,死亡率高,預(yù)后差。放射125Ⅰ粒子支架植入術(shù)是目前治療食管癌并發(fā)食管氣管瘺的有效方案,其可實(shí)現(xiàn)近距離放療,靶區(qū)劑量高,且副

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