鼻咽癌患者放射治疗中发生医院感染的危险因素研究

目的探讨引起鼻咽癌患者在放射治疗中发生医院感染的危险因素,提出预防控制措施。方法制定统一调查表,对150例接受放射治疗的鼻咽癌住院患者进行放射治疗过程中发生医院感染情况调查。结果 150例鼻咽癌患者在住院治疗过程中,119例发生不同程度的医院感染,总的感染率为79.33%,其中以口腔黏膜感染为主,感染率为54.00%,皮肤感染率为24.00%,上呼吸道感染率为1.33%。放射治疗第1周后发生医院感染的人数最多,其次为放疗第2周后,累计发病率呈持续上升状态。晚期鼻咽癌患者的医院感染发生率高于早期患者,差异有统计学意义(P<0.05);发生医院感染的鼻咽癌患者其口咽黏膜反应程度、放射野皮肤反应程度均高于未发生医院感染患者,差异有统计学意义(P<0.05),平均体质量、血红蛋白量、白细胞总数均低于未发生医院感染患者,差异有统计学意义(P<0.05)。四分类有序Logistic回归分析显示,口咽黏膜反应、放射野皮肤反应程度越大,体质量越轻,血红蛋白、白细胞数越低,越容易发生医院感染且严重程度越高。结论鼻咽癌患者在接受放射线治疗中,医院感染发生的危险因素主要是由于放射线对口腔黏膜、放射野皮肤的损害,以及对骨髓的抑制,白细胞减少,损害免疫系统,同时造成体质变弱,体质量减轻、血红蛋白减少,使抵抗力下降。因此,降低和预防医院感染的发生必须针对这些因素而制定相应措施。

Risk Factors of Nosocomial Infection in Radiotherapy for Patients with Nasopharyngeal Carcinoma

Objective To explore the incidence of nosocomial infection(NI) and its risk factors during the radiotherapy for patients with nasopharyngeal carcinoma(NPC),and to offer the measure of prevention and control of NI.Methods A self made questionnaire was used for a survey carried out among 150 NPC inpatients during their receiving of radiotherapy for their conditions of NI.Results Among all the 150 patients,119 had NI to a certain degree,with a total infection incidence of 79.33%.The top rate of infection of NI was 54.00% in the oral mucosa,followed by 24.00% in the skin and 1.33% in the upper respiratory tract.The NI case occurred mostly the 1st week after the radiotherapy,followed by the 2nd week after the radiotherapy,with a constantly increased tendency of accumulative incidence.The NI rate was significantly higher in advanced than in early NPC(P<0.05).Compared with NPC patients without NI,the oral mucosal reaction and radiodermatitis in NPC patients with NI were significantly severer(P<0.05);and the average weight,hemoglobin content and total count of leukocytes were significantly lower(P<0.05).The analysis of multinomial ordinal logistic regression showed that the more seriousness of oral mucosal reaction and radiodermatitis,the slighter the weight,the lower the hemoglobin content and the leukocyte count,and thus the easier the occurrence of NI the higher the severity.Conclusion The risk factors for NI occurrence in radiotherapy for NPC patients is that the radiation makes lesions of oral mucosal and skin of radiation field,arrest of bone marrow,leukocytopenia,and impairment of immune system;at the same time,it makes weakness of constitution,decreased weight,lowered hemoglobin.With reduced resistance.Therefore,the relative prevention and control measures for NI should be established for those factors.