论文部分内容阅读
目的探讨胃癌患者术后中心静脉导管(CVC)真菌感染的病原学和发生率,分析其相关因素,提出有效地预防改进措施。方法对100例住院的胃癌手术患者(手术组)留置CVC的感染情况进行回顾,分析感染的相关因素。并与同时期52例术后化疗患者(化疗组)留置CVC的感染情况进行比较。结果手术组中12例发生CVC相关性真菌感染;其中8例单纯CVC感染,4例同时合并真菌血症。12例患者均为念珠菌感染,主要为近平滑念珠菌,占50.00%(6/12)。其感染与术后并发吻合口瘘可能有相关性,而与患者年龄、性别、手术方式,肿瘤大小和分期以及导管留置时间和置管位置无相关性。8例患者拔除CVC后感染自愈,4例真菌血症患者抗真菌治疗后3例痊愈,1例合并肺部念珠菌感染治疗无效死亡。化疗组无1例患者发生导管相关真菌感染,与手术组感染率相比差异有统计学意义(P<0.05)。结论胃癌手术后CVC相关真菌感染的主要病原菌是近平滑念珠菌,吻合口瘘可能是其高危因素,及时拔除感染的CVC,可有效地防治导管相关的血行感染。
Objective To investigate the etiology and incidence of fungal infection of central venous catheter (CVC) in patients with gastric cancer after operation, analyze the related factors and propose effective measures to prevent it. Methods 100 cases of hospitalized patients with gastric cancer surgery (surgery group) were retrospective CVC infection, infection-related factors. And compared with 52 cases of postoperative chemotherapy patients (chemotherapy group) CVC infection. Results In the operation group, 12 cases of CVC-associated fungal infection occurred. Among them, 8 cases were infected with CVC only and 4 cases were complicated with fungal exacerbation. All 12 patients were Candida infections, mainly Candida parapsilosis, accounting for 50.00% (6/12). The infection and postoperative anastomotic fistula may be related, but with the patient age, gender, surgical procedures, tumor size and staging and catheter indwelling time and catheter position no correlation. Eight patients were self-healing after removal of CVC. Four patients with fungal bacilli were cured after antifungal therapy, and one patient died of infection with pulmonary candidiasis. There was no catheter-related fungal infection in 1 patient in the chemotherapy group, which was significantly different from the infection rate in the operation group (P <0.05). Conclusion The main pathogen of CVC-related fungal infection after gastric cancer surgery is Candida parapsilosis. Anastomotic fistula may be the risk factor for timely removal of CVC infection, which can effectively prevent and treat catheter-related bloodstream infections.