168例院内肺部真菌感染的临床分析

168 case of Nosocomial Pulmonary Fungal Infections

目的 探讨院内肺部真菌感染的易患因素、临床表现、诊断、治疗和预后。方法 对1996年1月～2003年12月间168例院内肺部真菌感染患者的，临床资料进行回顾性分析。结果 在168例院内肺部真菌感染的病例中均有基础疾病，以原发肺部疾病（50例）、恶性肿瘤（41例）、结缔组织疾病（22例）以及慢性肾脏疾病（16例）最多见；其感染的常见诱因有长期使用广谱抗生素（68例）、长期应用糖皮质激素（40例）、低蛋白血症（38例）及免疫抑制剂（24例）、白细胞减少（16例）、气管切开或气管插管（16例）；感染的病原菌仍以白色念珠菌、热带念珠菌、平滑念珠菌和曲霉菌等为主；在，临床上66．76％的病人有发热，白细胞增高者占38．6％；治疗主要应用氟康唑和二性霉素B治疗；治愈、好转108例、死亡24例；近年真菌感染的发生率明显增高。结论 近年来院内肺部真菌感染有逐年增加的趋势，这与长期大剂量广谱抗生素、大剂量糖皮质激素以及免疫抑制剂应用、化疗等密切相关，也与检测技术的提高有关；肺部真菌感染的死亡率仍较高，非白念珠菌的感染逐渐增加。

Objective To investigate the risk factor, manifestation, diagnosis, therapy, outcome and prognosis; Methods The clinical data of 168 case with nosocomial pulmonary fungal infection were retrospectively analyzed; Results All case had underlying condition, including primary pulm-nary disease（n=50）, tumor（n=41）, rheumatic disease（n=22）, chronic renal disease（n=16）; The predisposing factors or risk factors for nosocomial pulmonary fungal infections included use of high dose broad spectrum antibiotics over a long period, longer term use of steroids, hypoalbuminemia immunosuppressant, tracheotomy or endotracheal intubation; the main pathogenic fungal species were Candida albicans, C, tropicalis, C, glabrata and Aspergillus species; the clinical manifestations included fever（66.76%）, leucocytosis（38.6%）; Fluconazole and Amphoteicin B were used, the overall mortality rate was 14.28%（24 / 168）, 108 patients were cured or made improvement; Conclusion The incidence of fungal infection is recently which is correlated with use of high dose broad spectrum antibiotics over a long period, longer term use of high dose steroids, hypoalbuminemia, immunosuppressant and improvement of examination skills, etc.Early diagnosis is impotent.