呼吸机相关性肺炎假丝酵母菌属感染的危险因素及预后分析

Risk Factors of Early-onset and Late-onset Pulmonary Candidiasis Related to Mechanical Ventilation and Analysis of Prognostic Factors Associated with Mortality

目的探讨机械通气患者呼吸机相关性肺炎假丝酵母菌属感染危险因素的差异及影响预后的因素。方法回顾性分析医院114例机械通气>48h的患者,将其中50例呼吸机相关性肺炎假丝酵母菌属感染者分为早发型感染组和迟发型感染组,以非假丝酵母菌属感染者为对照组,采用单因素(χ2检验)及多因素Logistic回归进行统计学分析;将感染组以死亡病例为病例组,以非死亡病例为对照组进行死亡危险因素χ2分析。结果频繁更换抗菌药物(OR=5.828,P=0.001)、患>2种基础疾病(OR=4.538,P=0.008)是早发型感染的独立危险因素;高龄(OR=5.684,P=0.000)、血白蛋白<25g(OR=2.279,P=0.000)是迟发型感染的独立危险因素;预防性抗真菌治疗(OR1=0.064,P1=0.004;OR2=0.561,P2=0.014)是两者的保护性因素;昏迷(P=0.001)、肾功能异常(P=0.002)、患>2种基础疾病(P=0.026)是影响预后的危险因素。结论早发型和迟发型呼吸机相关性肺炎假丝酵母菌属感染危险因素是有差异的,及时发现感染和影响预后的危险因素,采取针对性措施,有助于改善机械通气患者的预后。

OBJECTIVE To investigate the difference in risk factors between early-onset infection and late-onset infection of invasive pulmonary candidiasis in patients who accepted mechanical ventilation,and analysis the prognostic factors associated with mortality.METHODS A retrospective case-control study was performed,including 114 cases of who have accepted mechanical ventilation more than 48 hours.The infected 50 cases were sorted to early-onset infection group and late-onset group,no-infected group as the control group,and univariate analysis（χ^2-test）and multivariate logistic regression analysis perform were,and the prognostic factors associated with mortality were analyzed with univariate analysis（χ^2-test）.RESULTS The univariate analysis and multivariate logistic regression showed that the independent risk factors for early-onset invasive pulmonary candidiasis infection included changes in antibiotics more than 2-times（OR=5.828,P=0.001）,cases with more than two kinds of diseases（OR=4.538,P=0.008）,at the same time,eld（OR=5.684,P=0.000）and serum albumn less than 25 grams（OR=2.279,P=0.000）were the independent risk factors for late-onset infection.Prophylactic antifungal treatment（OR1=0.064,P1=0.004;OR2=0.561,P2=0.014）was a protective factor for both of them.The risk factors associated with prognosis included with more than two kinds of diseases（P=0.026）,coma（P=0.001）and renal dysfunction（P=0.002）.CONCLUSIONS The risk factors between early-onset infection and late-onset infection of invasive pulmonary candidiasis in patients who accepted mechanical ventilation.is different Finding these risk factors in time and starting the necessary and accurate treatment earlier are important for improving prognosis.