肝胆外科病房深部真菌感染临床分析及护理干预

Clinical analysis and nursing intervention of deep fungal infection of patients in hepatobiliary surgical wards

[目的]探讨肝胆外科病房深部真菌感染的危险因素及护理干预措施。[方法]分析2001年1月—2006年12月肝胆外科病房深部真菌感染58例病人的临床资料和护理记录。总结病人院内深部真菌感染原因、临床特点及护理措施。[结果]58例共分离出69株菌株,其中白色念珠菌为主要构成,占44.9%;深部真菌感染的疾病主要有:重症急性胰腺炎、急性梗阻性胆管炎、肝胆胰腺恶性肿瘤、胰漏、胆漏、肝脓肿、肝移植。长期广谱抗生素的使用、机械通气、中心静脉置管、TPN的使用、肝功能障碍、皮质类固醇激素的使用、高龄、糖尿病是真菌感染的高危因素。[结论]深部真菌感染是肝胆外科病房常见的并发症,给病人的预后带来极大危害。提高和增强机体的抵抗力,合理使用抗生素,注意观察药物的副反应,减少侵入性操作,加强基础护理,加强无菌观念是防止深部真菌感染的有效护理措施。

Objective： To probe into risk factors and nursing intervention measures for deep fungal infection patients in hepatobiliary surgical wards, Methods.To analyze clinical data and nursing records of 58 deep fungal infection patients in hepatobiliary surgical wards from January 2001 to December 2006. Causes, clinical characteristics and nursing measures of pa- tients with nosocomial deep fungal infections have been summarized. Results：Totally 69 strains of fungi were isolated from 58 all patients. Candida albicans is one of the major strains, accounting for 44.9%. Deep fungal infections were mainly included- severe acute pancreatitis, acute obstructive cholangitis, hepatobiliary and pancreatic malignant tumors, pancreatic juice leakage, bile leakage, liver abscess, and liver transplantation. High risk factors of fungal infection of patients were as followings ： long - term use of broad-spectrum antibiotics, mechanical ventilation, central venous cathe-terization, use of TPN, liver dysfunction, use of corticosteroids,old age, and diabetes. Conclusion： Deep fungal infection is a common complication of patients in hepatobiliary surgical wards. It may bring great harm to the prognosis of patients. To enhance and to strengthen the resistance of patients, rational use of antibiotics,to observe the side effects of drugs,to reduce the invasive procedures, to strengthen basic care, and to strengthen the concept of asepsis are effective nursing measures for preventing deep fungal infection of patients.