恶性血液病患者深部真菌感染临床分析及护理干预

Clinic analysis and nursing intervention measures for deep fungal infections of patients with Hematologic Malignancies

目的:探讨恶性血液病患者深部真菌感染的危险因素及护理干预措施。方法:分析2006年1月-2010年9月住院的126例恶性血液病合并深部真菌感染病人的临床资料和护理病历。总结病人院内深部真菌感染的原因、临床特点及护理措施。结果:126例共分离出138株菌株,以白色念珠菌为主,占48.5%。感染部位最常见为肺部,占67.2%。基础疾病包括急性髓细胞白血病、急性淋巴细胞白血病、骨髓增生异常综合征、慢性淋巴细胞白血病、非霍奇金淋巴瘤、多发性骨髓瘤等。反复化疗、长期广谱抗生素的使用、糖皮质激素的使用、高龄及合并糖尿病是真菌感染的高危因素。结论:深部真菌感染是恶性血液病常见的并发症。加强病房消毒隔离管理,对高危人群进行监测和采取预防性的护理措施,加强卫生宣教,遵医嘱早期使用抗真菌药物治疗是预防深部真菌感染的有效措施。

Objective:To investigate risk factorsand nursing intervention measuresfor deep fungal infectionsof patientswith hematologic malignancies. Methods: To analyze clinical data and nursing records of 126 deep fungal infections of patients with hematologic malignancies from Jan. 2006 to Sep. 2010. Causes,clinical characteristics and nursing measures of patients with nosocomial deep fungal infections have been summarized. Results: Totally 138 strains of fungi were isolated from 126 patients. Candida albicans is the major strain accounting for 48. 5 % . Lung is the commonest involved site accounting for 67. 2% . Deep fungal infections were mainly included in acute myeloid leukemia,acute lymphocytic leukemia,myelodysplastic syndrome,chronic lymphocytic leukemia,non - Hodgkin lymphoma,multiple myeloma, et al. High risk factors of fungal infection of patients were as followings: repeated chemotherapy,long term use of broad - spectrum antibiotics,use of corticosteroids, old age and diabetes. Conclusion: Deep fungal infection is a common complication of patients with hematologic malignancies which brings great harm to the patients. To enhance management of sterilization and segregation ,monitor high risk patients and take prophylaxis interventions,to strengthen public health education,use antifungal agents empirically under supervision of a physician are effective measures for preventing deep fungal infection.