鼻咽癌单纯放疗和联合放化疗并医院感染情况调查与分析（福建医科大学附属医院漳州市医院放疗科363000）【摘要】目的调查分析鼻咽癌患者单纯放疗和联合放化疗医院感染情况。方法对在2011-1-1至2013-7-31期间我院收治的鼻咽癌病例436例的临床资料进行回顾性调查分析医院感染情况。结果在436例鼻咽癌患者中并发感染的病例有152例，感染率为34.86%；前者平均住院天数为54.8天、后者63天；不同治疗方法出现感染的比例明显不同：单纯放疗、诱导化疗、同期放化疗感染率为10.2%、36.7%和46.3%（P值均<0.05）。感染发生的主要部位依次为口腔和咽部粘膜125例,占82.2%；肺部16例，占10.5%；气管-支气管13例，占8.5%；其中多部位感染8例，占5.3%。感染的病原菌有68例真菌感染或合并真菌感染，达44.7%，95例分离出病原菌106株，前三位为鲍曼不动杆菌33株（33/95、构成比34.7%），肺炎克雷伯氏31株（31/95、构成比32.6%），大肠埃希菌20株（20/95、构成比21.1%）；男女性别感染发生比例无差别；不同年龄段除＜40岁感染率较低以外（21.5%，P>0.05），40-75岁感染发生率亦无差异。结论鼻咽癌放疗患者联合化疗特别是同步化疗医院感染明显增加，与住院时间长、治疗毒性反应增加有关。【关键词】医院感染鼻咽癌放射治疗同期放化疗诱导化疗【中图分类号】R730.5【文献标识码】A【文章编号】2095-1752（2013）36-0064-02NasopharyngealcarcinomaradiotherapyandcombinedradiationandchemotherapytheinvestigationandanalysisofinfectioninhospitalHuangjianli,Linkunhua,Chenlimin，Chenweilin,Zhuoyanhong.DepartmentofradiotherapyOncology,ZhangzhouMunicipalHospitalofFujian.【Abstract】Objective:Investigationandanalysisofpatientswithnasopharyngealcarcinomaradiotherapyandradiotherapycombinedwithchemotherapyinhospitalinfection.Methods:from2011-1-1to2013-7-31duringtheNPCpatientsadmittedinourhospital436casesofclinicaldatawereretrospectivelyanalyzedinfectioninhospital.Results:in436casesofnasopharyngealcarcinomapatientscomplicatedwithinfectionin152cases,theinfectionratewas34.86%;theaveragehospitalstaywas54.8days,63daysforthelatter;differenttreatmentinfectionratiosignificantlydifferent:radiotherapy,chemotherapy,radiotherapyandchemotherapyinfectionratewas10.2%,36.7%and46.3%(allP<0.05).Theinfectionmainlyoccursintheoralandpharyngealmucosain125cases,accountingfor82.2%;lungin16cases,accountingfor10.5%;trachea-bronchusin13cases,accountingfor8.5%;theinfectionofmultiplesitesin8cases,accountingfor5.3%.Pathogeninfectionhasreached44.7%in68casesofinfection,fungalinfectionorcombinedwithfungalinfection,95casesof106strainsofbacteriawereisolated,Topthree33strainsofAcinetobacterbaumannii(33/95,aratioof34.7%),Klebsiellapneumoniae31strains(31/95,32.6%),20strainsofEscherichiacoli(20/95,ratioof21.1%);Genderinfectionratioofnodifference;differentage<40yearsinadditiontolowertheinfectionrateofoutside(21.5%,P>0.05),40-75infectionrateandnodifference.Conclusion:Concurrendchemoradiotherapyinpatientswithnasopharyngealcarcinomaespeciallysignificantlyincreasedinfectioninhospital.Associatedwithincreasedlengthofhospitalization,treatmenttoxicity.【Keywords】Hospitalinfectionnasopharyngealcarcinomaradiotherapyconcurrendchemoradiotherapyinductionchemotherapy鼻咽癌治疗的首选方案是放射治疗，但鼻咽癌放疗可至口咽黏膜损害；唾液腺分泌减少，口腔自洁免疫功能下降；加上放疗后食欲下降、进食量减少、白细胞减少至全身免疫功能下降等原因，极易发生口咽黏膜的感染。特别是局部中晚期患者,放疗加化疗综合治疗的广泛应用加重急性反应，增加感染机会。黏膜感染不仅加重咽痛、影响进食，严重者还会并发其他部位感染，致放疗中断、甚至威胁生命。对这些病人的情况进行调查分析对防治感染非常有意义...