肺癌患者术后合并肺部感染的临床特点及影响因素

目的探讨肺癌患者术后合并肺部感染的临床特点及其影响因素。方法选取2016年8月至2018年8月间青岛市市立医院东院区收治的89例肺癌手术患者,按照术后是否合并肺部感染分为肺部感染组(46例)与非肺部感染组(43例)。分析肺部感染组患者的病原菌感染情况,采用单因素及多因素Logistic回归分析,探究肺癌患者术后合并发生肺部感染的影响因素。结果46例肺部感染患者中,革兰阴性菌27例(58. 7%),革兰阳性菌16例(37. 8%),真菌3例(6. 5%)。两组患者年龄、糖尿病、侵入性操作、慢性阻塞性肺疾病、切口明显疼痛和手术时间比较,差异均有统计学意义(均P <0. 05);性别和预防性使用抗菌药比较,差异无统计学意义(P> 0. 05)。上述因素纳入多因素Logistic回归分析,高龄、切口疼痛明显、慢性阻塞性肺疾病和糖尿病为肺癌患者术后合并肺部感染的独立影响因素,差异均有统计学意义(均P <0. 05)。结论肺癌患者术后合并肺部感染时,病原菌以革兰阴性菌为主,配合积极有效的预防措施,防止术后肺部感染。     

食管癌术后化疗患者肺部感染的病原菌分析及耐药性分析

目的分析食管癌术后化疗患者肺部感染病原菌的特点,并探讨病原菌耐药性,指导临床选择合理抗菌药物治疗食管癌化疗后肺部感染。方法选择182例食管癌术后化疗合并肺部感染的患者,分析病原菌分布情况及耐药性。结果182例患者共分离出病原菌236株,其中革兰阴性菌151株,革兰阳性菌56株,真菌29株。革兰阳性菌中金黄色葡萄球菌占比最高,其次为表皮葡萄球菌、肺炎链球菌;革兰阴性菌中铜绿假单胞菌占比最高,其次为鲍曼不动杆菌、肺炎克雷伯菌;真菌中以白色假丝酵母菌为主。革兰阳性菌及革兰阴性菌中主要病原菌均对多种常用抗菌药物存在不同程度耐药,金黄色葡萄球菌对头孢唑林、庆大霉素、红霉素及青霉素有较严重耐药(耐药率≥70.00%),对克林霉素及万古霉素有较低耐药(耐药率<30.00%);表皮葡萄球菌对头孢唑林、头孢曲松、庆大霉素、红霉素及青霉素有较严重耐药,对万古霉素不耐药;铜绿假单胞菌对头孢唑林及复方新诺明有较严重耐药,对亚胺培南、美罗培南、头孢呲肟、哌拉西林及阿米卡星有较低耐药;鲍曼不动杆菌对头孢唑林及氨曲南有较严重耐药,对亚胺培南及美罗培南有较低耐药。结论食管癌术后化疗合并肺部感染患者的病原菌主要为革兰阴性菌、革兰阳性菌、对多种抗菌药物存在不同程度的耐药性,应针对患者病原菌类型选择具有较低耐药性的抗菌药物,以避免抗菌药物滥用,提高肺部感染治疗效果。     

口腔鳞状细胞癌患者术后局部感染的危险因素

目的 探讨口腔鳞状细胞癌患者术后局部感染的危险因素.方法 收集275例口腔鳞状细胞癌患者的临床资料,统一制表并登记,统计病原学分析结果及一般资料,分析院内感染的危险因素.结果 90例口腔鳞状细胞癌术后局部感染患者中共分离出107株病原菌,主要为革兰阳性菌(59.81％),其中金黄色葡萄球菌(27.10％)较为常见;其次为革兰阴性菌(40.19％),其中铜绿假单胞菌(18.69％)较为常见.单因素分析结果显示,不同年龄、体重指数(BMI)、肿瘤部位、肿瘤直径、合并糖尿病情况、合并慢性阻塞性肺疾病情况、合并症数量、缺损修复方案、手术时间和输血情况的口腔鳞状细胞癌患者术后局部感染情况比较,差异均有统计学意义(P﹤0.05).多因素分析结果显示,年龄≥60岁、BMI﹤20 kg/m2、合并糖尿病、合并症数量﹥2个、缺损修复区域/游离皮瓣、手术时间﹥6 h均是口腔鳞状细胞癌患者术后局部感染的独立危险因素(P﹤0.05).结论 口腔鳞状细胞癌患者术后局部感染的危险因素较多,可通过充分术前评估尽可能地减少危险因素对口腔鳞状细胞癌患者造成的影响.     

胃癌合并2型糖尿病患者的围手术期处理

目的 探讨胃癌合并2型糖尿病(T2DM)患者的围手术期处理方法.方法 对28例胃癌合并T2DM患者的临床资料进行回顾性分析.结果 28例患者的手术根治切除率100%,切口甲级愈合25例,术后并发症3例(其中切口感染2例,肺部感染1例).所有患者围手术期血糖控制良好,均痊愈出院.结论 正确有效控制围手术期血糖水平能够保证...     

结直肠癌患者术后切口感染危险因素分析

目的结直肠癌手术切口感染会导致病情加重和愈合时间延长,本研究分析结直肠癌患者术后切口感染危险因素,为制定相关防治措施提供参考。方法回顾性分析2014-01-01-2018-12-30河北医科大学第一医院普通外科接受手术治疗的282例结直肠癌患者临床资料,分析感染患者手术切口感染的相关因素和病原菌构成。结果术后切口感染17例,感染率为6.03%(17/282);开腹手术切口感染率为10.58%(11/104),腹腔镜手术切口感染率为3.37%(6/178),差异有统计学意义,P<0.05。17例切口感染者中共检出18株病原菌,革兰阳性菌6株(33.33%),革兰阴性菌10株(55.56%),真菌2株(11.11%)。单因素分析显示,结直肠癌患者术后切口感染与手术方式、患者年龄、体质量指数(body mass index,BMI)、切口长度、手术时间、是否合并糖尿病有关,均P<0.05;与患者性别、Duke分期、手术部位和术中出血量无关,均P>0.05。Logistic回归分析显示,年龄>60岁、BMI>24kg/m2、有糖尿病是结直肠癌患者术后切口感染的危险因素。结论结直肠癌患者术后切口感染的发生与手术方式、患者年龄、BMI、切口长度、手术时间、是否合并糖尿病有关,应采取针对性的防治措施,以降低结直肠癌患者术后切口感染的发生。     

血液恶性肿瘤患者化疗后血流感染发生率、病原菌分布情况及其影响因素分析

目的 探讨血液恶性肿瘤患者化疗后血流感染发生率、病原菌分布情况及其影响因素.方法 将60例血液恶性肿瘤患者化疗后血流感染的发生情况和病原菌分布情况进行统计分析,并检测病原菌的耐药性,分析其相关影响因素.结果 60例血液恶性肿瘤患者化疗后,发生血流感染22例,感染发生率为36.67％,其中革兰阳性菌感染7例,占31.82％;革兰阴性菌感染14例,占64.63％;真菌感染1例,占4.55％.革兰阳性菌以粪肠球菌为主,对万古霉素最敏感,革兰阴性菌以大肠埃希菌和肺炎克雷博菌为主,对美罗培南、亚胺培南最为敏感.单因素分析结果显示,年龄、化疗周期、中心静脉置管时间、基础疾病、脏器功能衰竭数目、住院时间均可能是血液恶性肿瘤患者发生血流感染的影响因素(P﹤0.05);而不同性别、凝血功能障碍情况均可能不是血液恶性肿瘤患者发生血流感染的影响因素(P﹥0.05).进一步行多因素Logistic回归分析,结果显示,年龄≥60岁、化疗周期﹥5个、中心静脉置管时间﹥20天、有基础疾病、脏器功能衰竭数目≥2个、住院时间≥20天均是血液恶性肿瘤患者化疗后发生血流感染的独立危险因素(P﹤0.05).结论 血液恶性肿瘤患者化疗后易发生血流感染,主要以革兰阴性菌感染为主,血流感染的发生与多个因素相关,临床治疗时应针对性预防.     

宫颈癌术后感染状况及其与Caspase-1、IL-1β表达情况的相关性

目的探讨宫颈癌术后感染状况及其与半胱氨酸天门冬氨酸蛋白水解酶-1(Caspase-1)和白细胞介素-1β(IL-1β)表达的相关性。方法选取宫颈癌手术患者共297例,观察术后感染率,并对感染患者感染病原菌分布检测。同时对所有患者术后组织样本内Caspase-1、IL-1β表达情况进行检测。结果手术后有15%的患者出现术后感染,在术后感染患者病原菌分布检测中可以看出,革兰阴性菌占感染病原菌的主要部分(P<0.05)。同时对所有患者组织样本的Caspase-1、IL-1β表达情况进行比较发现,术后感染组患者血清内的Caspase-1、IL-1β阳性表达情况明显高于未感染组。结论宫颈癌术后感染主要为革兰阴性菌所致,因此术后应进行必要的抗菌处置。同时,术后积极检测患者血清Caspase-1、IL-1β表达情况,可以及时预防及治疗术后感染的发生。     

老年肺癌患者化疗后肺部感染的病原菌分布及其对免疫功能的影响

目的:探讨老年肺癌患者化疗后肺部感染的病原菌分布及其对免疫功能的影响。方法:选取我院于2015年1月至2018年1月收治的老年肺癌化疗患者183例,分析化疗后肺部感染病原菌和耐药性、肺部感染与未感染患者免疫功能指标变化。结果:肺癌患者化疗后发生肺部感染82例,发生率为44.81%;共分离培养病原菌93株,革兰阴性菌59株、革兰阳性菌30株、真菌4株,革兰阴性菌中,主要为铜绿假单胞菌27株、肺炎克雷伯菌13株;革兰阳性菌中,主要为金黄色葡萄球菌11株、凝固酶阴性葡萄球菌10株。主要革兰阴性菌中,铜绿假单胞菌对头孢哌酮和头孢他啶耐药率较高,分别为92.59%和85.18%;肺炎克雷伯菌对头孢吡肟和头孢他啶耐药率较高,分别为84.61%和76.92%。主要革兰阳性菌中,金黄色葡萄球菌对青霉素G和红霉素耐药率较高,分别为90.91%和81.82%;凝固酶阴性葡萄球菌对红霉素和青霉素G耐药率较高,分别为100.00%和80.00%。肺部感染组CD3+、CD4+和CD4+/CD8+低于未感染组,有统计学差异（P＜0.05）。结论:老年肺癌患者化疗后肺部感染的病原菌分布主要为革兰阴性菌,主要革兰阴性菌对头孢类耐药率较高,主要革兰阳性菌对青霉素和红霉素耐药率较高,且肺部感染患者免疫功能明显下降。     

肿瘤患者院内下呼吸道感染病原菌分布及耐药性分析

目的了解肿瘤患者院内下呼吸道感染病原菌分布及耐药情况。方法回顾性分析326例住院肿瘤患者下呼吸道感染痰细菌分离株及耐药监测情况。结果共分离细菌342株，其中革兰阴性菌占53．2％，以铜绿假单胞菌、大肠埃希菌、肺炎克雷伯菌为多见；革兰阳性菌占18．7％，主要是金黄色葡萄球菌；真菌占28．1％；培养出2种致病菌的患者占48．6％，其中革兰阴性菌合并真菌感染占混合感染的65．4％。致病菌对常用抗生素都不同程度地产生了耐药性，对青霉素、氨苄西林耐药率最高，对亚胺培南／西司他丁的耐药率最低，未发现对万古霉素耐药的金黄色葡萄球菌。结论肿瘤患者院内下呼吸道感染的主要病原菌为革兰阴性菌，细菌耐药性严重，并且具有多重耐药性。治疗时应重视病原菌培养和药物敏感试验，合理使用抗生素。     

消化系统肿瘤患者术后真菌感染病原菌分布及耐药性分析

目的 分析消化系统肿瘤患者术后真菌感染病原菌分布特点及耐药情况,从而为临床预防和诊治提供依据.方法 随机选取消化系统肿瘤术后患者1000例为调查对象,其中合并真菌感染患者91例,感染率为9.1％.收集标本,对检出的病原菌进行菌属鉴定,同时进行药敏试验.结果 年龄、远处转移以及肿瘤分期是影响肿瘤患者术后真菌感染的因素(P＜0.05).91例感染患者中,呼吸系统感染72例,占79.12％,消化系统感染17例,占18.68％,泌尿系统感染3例,占3.30％;91株真菌中,白色假丝酵母-菌59株,占64.84％,热带假丝酵母菌12株,占13.19％,光滑假丝酵母菌11株,占12.09％,克柔假丝酵母菌7株,占7.69％,其他2株,占2.20％;91例患者中,合并细菌二重感染58例,占63.74％.以革兰阴性菌为主,占94.83％,其中包括肺炎克雷伯菌、鲍氏不动杆菌、大肠埃希菌、铜绿假单胞菌等.合并革兰阳性菌占5.17％,为葡萄球菌属;白色假丝酵母菌、热带假丝酵母菌、光滑假丝酵母菌以及克柔假丝酵母菌对两性霉素、伏立康唑耐药性为0,对氟康唑和氟康唑有较低耐药率.结论 消化系统肿瘤术后患者真菌感染以白色假丝酵母菌为主,且多合并细菌感染,以革兰阴性菌为主,好发部位为呼吸道,临床上应根据药敏试验结果采取有效的药物治疗.     

Etoposide, dexamethasone, cytarabine, and cisplatin in vincristine, doxorubicin, and dexamethasone-refractory myeloma

Based on remarkable activity in refractory lymphomas, a combination of etoposide, cisplatin (both administered by 4-day continuous infusions), cytarabine (Ara-C), and dexamethasone (EDAP) was evaluated in 20 patients with advanced myeloma refractory to standard melphalan and prednisone (MP) and/or vincristine, Adriamycin (doxorubicin; Adria Laboratories, Columbus, OH), and dexamethasone (VAD) and even to high doses of melphalan (HDM) (seven patients). Forty percent of patients responded regardless of previously recognized risk factors (eg, duration of drug resistance, tumor mass, and serum lactic dehydrogenase [LDH] level). While the median survival was only 4.5 months, patients with good performance (Zubrod less than 2) and low or intermediate tumor stage survived more than 14 months compared with only 2 months for the remaining group. EDAP could be readily administered in the outpatient clinic, but neutropenic fever prompted hospital admission in 80% of patients, half of whom developed penumonia and sepsis, a fatal outcome in four patients. Severe myelosuppression was of short duration, so that subsequent cycles could be administered every 3 to 4 weeks. No serious extramedullary toxicity, including renal toxicity, was encountered. Marrow toxicity and hence infectious complications may be reduced by elimination of Ara-C without compromising treatment efficacy. We conclude that the lack of cross-resistance with VAD and even HDM makes EDAP or a similar combination an attractive regiment to be formally explored in an alternating sequence with VAD in high-risk myeloma.     

Premenopausal intakes of vitamins A, C, and E, folate, and carotenoids, and risk of breast cancer.

Intakes of vitamins A, C, and E, folate, and carotenoids have been hypothesized to reduce the risk of breast cancer. However, previous epidemiological studies on these nutrients and breast cancer risk have been inconclusive, and have included primarily postmenopausal women. We examined the intake of these nutrients in relation to breast cancer risk among 90,655 premenopausal women ages 26-46 years in 1991 in the Nurses' Health Study II. Nutrient intake was assessed with a validated food-frequency questionnaire at baseline in 1991 and in 1995. During 8 years of follow-up from 1991 to 1999, we documented 714 incident cases of invasive breast cancer. Overall, none of the vitamins and carotenoids was strongly related to a reduced risk of breast cancer. However, intake of vitamin A, including preformed vitamin A and carotenoids, was associated with a reduced risk of breast cancer among smokers; participants in the highest quintile of total vitamin A intake had a multivariate relative risk of 0.28 (95% confidence interval 0.12-0.62; P, test for trend <0.001; P, test for interaction <0.001) compared with those in the lowest quintile of intake. We found no evidence that higher intakes of vitamins C and E, and folate in early adult life reduce risk of breast cancer. However, intake of vitamin A may be related to a reduced risk of breast cancer among smokers.     

Selenium, lycopene, alpha-tocopherol, beta-carotene, retinol, and subsequent bladder cancer

To examine the association between serum nutrients and the development of bladder cancer we measured selenium, alpha-tocopherol, lycopene, beta-carotene, retinol, and retinol-binding protein in serum collected from 25,802 persons in Washington County, MD, in 1974. Serum samples were kept frozen at -70 degrees C. In the subsequent 12-year period, 35 cases of bladder cancer developed among participants. Comparisons of serum levels in 1974 among cases and two matched controls for each case showed that selenium was significantly lower among cases than controls (P = 0.03), lycopene was lower among cases at a borderline level of significance (P = 0.07), and alpha-tocopherol was nonsignificantly lower (P = 0.13). For selenium there was a nearly linear increase in risk with decreasing serum levels (P = 0.03). When examined by tertiles, the odds ratio associated with the lowest tertile of selenium compared to the highest tertile was 2.06. Serum levels of retinol, retinol-binding protein, and beta-carotene were similar among cases and controls. These results support a role for selenium in the prevention of bladder cancer.