ICU患儿肺部真菌感染的危险因素分析及对策

Risk factors of pulmoary fungal infection in pediatric intensive care unit and its counteractive strategy

目的分析重症监护病房患儿肺部真菌感染的危险因素,探讨控制对策及治疗措施。方法采用回顾性调查方法对2003年1月—2007年2月PICU收治的1057例危重症患儿进行调查,对肺部真菌感染率、感染相关危险因素、病原学特点及预防控制、治疗效果进行分析。结果发生肺部真菌感染48例,PICU肺部真菌感染发生率为4.54%,肺部真菌感染的相关危险因素主要有住院时间长、短期内反复住院、使用广谱抗生素、肾上腺皮质激素及免疫抑制剂的应用、机械通气及溺粪。病原菌主要有白色念珠菌、光滑念珠菌、热带念珠菌、克柔念珠菌、曲霉菌、毛霉菌等。经抗真菌治疗治愈28例(58.3%),显效9例(18.8%),无效10例(20.8%),放弃治疗1例(2.1%)。结论PICU患儿肺部真菌感染的发生与多种易感因素有关;合理使用抗生素、慎用肾上腺皮质激素、加强消毒隔离措施等是降低PICU患儿发生肺部真菌感染的关键;认识患儿发生真菌感染的易感因素、早期诊断、合理使用抗真菌药,是治愈儿童肺部真菌感染的关键。

Objectives To analyze the risk factors of pulmonary fungal infection in patients treated in pediatric intensive care unit（PICU）, and discuss the strategy of the prevention and treatment to the disease. Methods A total of 1057 patients admitted to PICU from January 2003 to February 2007 were investigated retrospectively. The incidence of pulmonary fungal infection, the risk factors of pulmonary fungal infection, characteristics of pathogens and preventive measures, treatment and outcome were analyzed. Results Forty-eight patients got pulmonary fungal infection, accounted for 4.54% of the total patients in PICU during the same periods. Risk factors included long time hospitalization, repeated hospitalization during a short period, receipt of broad-spectrum antibiotics or corticoid or immunosuppressant, application of mechanical ventilation and stercoraceous drowning. The pathogenic fungi included Candida albicans, Candida glabrata, Candida tropicalis, Candida krucei, Aspergilhas and Apophysomyces. With antifungal therapy, 28 patients were cured, 9 were relieved, 10 died and 1 gave up. Conclusions Selecting antibiotics Appropriately, using corticoids carefully, protective measures such as strengthening antisepsis and isolation are critical to reduce pulmonary fungal infection in PICU. Recognizing the predisposing factors, making diagnosis early, choosing antifungal drugs correctly are critical for successful treatment of pediatric patients with pulmonary fungal infection.