32例严重烧伤后真菌感染的临床分析

Clinical analysis of 32 fungal infection after severe burn

目的：探讨严重烧伤并发真菌感染的诊疗经验。方法：回顾分析1993-2006年32例严重烧伤并发真菌感染病例的临床资料。结果：真菌感染的好发时间为伤后7-34天,平均14天。常见部位：创面、静脉导管、呼吸道、口腔等;常见菌种：白色念珠菌、光滑球拟假丝酵母菌、曲霉菌、热带念珠菌、近平滑念珠菌等。主要诱因：（1）长时间使用高效广谱抗生素;（2）机体免疫力下降,防御机能严重受损;（3）糖皮质激素较长时间使用;（4）炎热、潮湿的环境因素;（5）静脉导管长时间留置。32例中,治愈20例,治愈率为62.5%;死亡12例,病死率为37.5%。结论：严重烧伤容易发生真菌感染,常与细菌感染并存,窄谱敏感抗生素加氟康唑（大扶康）、积极的创面处理、持续热风干燥治疗及定期翻身是治疗真菌感染的有效方法。

Objective：To summarize the clinical experience on the treatment of 32 fungal infection following severe bum. Method： 32 severely burned patients complicated with fungal infections in our department from 1993 to 2006 were analyzed. Results：Fungal infectious were likely to occur in the 7th - 34th day postbum, most commordy on the 14th days. The common sites were： wound, venous catheter, respiratory tract and mouth, etc. The most commordy detected fungi were Candida Albicaus, Candida Glabrata, Aspergilosus, Candida Tropicalis,Candida Parapsilosis. The usual reasons were as follows ： （ 1 ） Long - duration administration of highly effective and broad- spectrum antibiotics. （2） Severe damage to the defective mechanism due to immunodepression. （3） Comparatively long time application of glucocorticoid. （4） Hot and wet environment. （5） Long period of venous catheterization. Conclusions ：Fungal infections were inclined to occur in severely burned patients, usually accompanied by bacterial infections. The Four - in - one therapy, narrow -spectrum and sensitive antibiotics, together with Fluconazole （Diflucan）, and effective wound care were the promising treatment to fungal infections.