重症监护病房支气管哮喘急性发作患者真菌感染高危因素分析

High-risk factors of fungus infection in patients with acute attack of bronchial asthma in intensive care unit

目的:探讨重症监护病房支气管哮喘(BA)急性发作患者真菌感染高危因素。方法:选取重症监护病房的急性支气管哮喘伴随真菌感染患者52例作为观察组,选择同期收治的下呼吸道无真菌感染的支气管哮喘急性发作患者46例作为对照组。取观察组患者痰液、支气管分泌物,采用沙保培养基或粉吐温80培养基进行真菌培养,使用YBC鉴定卡进行真菌种类鉴定。观察并比较其真菌感染情况、治疗药物使用及并发症发生情况,并对其进行危险因素进行回归分析。结果:观察组52例真菌感染的BA患者中,14例患者有两种真菌混合感染,3例患者有多种真菌混合感染,42例患者同时伴有细菌感染;两组患者性别比较无统计学差异(P>0.05);观察组患者年龄、体重显著高于对照组(P<0.05);两组患者呼吸机使用、侵入性操作、慢性荨麻疹、糖尿病例数比较无统计学差异(P>0.05);观察组患者住院时间≥2周的比例显著高于对照组(P<0.05),抗生素使用种类>2种的比例显著高于对照组(P<0.05),抗生素使用时间≥10d的比例显著高于对照组(P<0.05),糖皮质激素使用患者比例显著高于对照组(P<0.05);以是否合并真菌感染为因变量,以年龄、体重、住院时间、抗生素使用种类和时间、糖皮质激素应用为自变量进行Logistic回归分析,结果显示,住院时间、抗生素使用种类和时间、糖皮质激素应用是BA急性发作患者真菌感染的影响因素(P<0.05)。结论:重症监护病房BA急性发作患者真菌感染的危险因素为住院时间的延长、抗生素的长期或联合使用以及糖皮质激素的应用。

Objective:To explore and analyze high-risk factors of fungus infection in patients with acute attack of bronchial asthma(BA)in intensive care unit(ICU).Methods:52 patients with acute BA and fungus infection in ICU were enrolled as observation group.42 patients with acute attack of BA and without fungus infection at lower respiratory tract in the same period were enrolled as control group.The sputum and bronchial secretions of patients in observation group were collected.Fungus culture was conducted by Sabouraud medium or cornmeal Tween 80 medium.YBC identification card was applied for fungus species identification.The status of fungal infection,the use of therapeutic drugs,and the occurrence of complications were observed and compared,and the risk factors were analyzed by regression analysis.Results:The identification results of sputum or bronchial secretions in 52 BA patients with fungus infection showed that there were 14 cases with mixed infection of two fungi,3 cases with mixed infection of various fungi,and 42 cases accompanied with bacterial infection.There was no significant difference in gender between the two groups(P>0.05).The age and weight of observation group were significantly higher than those of control group(P<0.05).There was no significant difference in number of patients with ventilator usage,invasive operation,chronic urticaria,and diabetes between the two groups(P>0.05).The proportion of patients with hospitalization time not shorter than 2 weeks in observation group was significantly higher than that in control group(P<0.05).The proportion of patients with antibiotics usage types more than 2 kinds in observation group was significantly higher than that in control group(P<0.05).The proportion of patients with antibiotics usage time not shor-ter than 10 days in observation group was significantly higher than that in control group(P<0.05).The proportion of patients with glucocorticoids usage in observation group was significantly higher than that in control group(P<0.05).Taking presence or absence of fungus infection as dependent variable,taking age,weight,hospitalization time,usage type and time of antibiotics,and glucocorticoid usage as independent variables,Logistic regression analysis was performed.The results showed that hospitalization time,usage type and time of antibiotics,and glucocorticoid usage were influencing factors of fungus infection in patients with acute attack of BA(P<0.05).Conclusion:The risk factors of fungus infection in patients with acute attack of BA in ICU include long hospitalization time,long-term or combination usage of antibiotics,and glucocorticoid usage.