颅脑手术后重症患者并发真菌感染临床分析

Clinical analysis on fungal infections in severe patients after craniotomy

目的探讨颅脑手术后重症患者并发真菌感染的易感因素、临床特点及其预防与治疗。方法回顾性分析某院神经外科2009年1月—2011年6月颅脑手术后并发真菌感染27例重症患者的临床资料。结果 27例颅脑手术后并发真菌感染者中,肺部感染12例,泌尿道感染8例,消化道感染4例,手术部位感染2例,血流感染1例;其中22例好转或治愈,病死1例,4例自动出院。颅脑手术后重症患者神志昏迷、广谱抗菌药物和肾上腺糖皮质激素的应用、各种有创性诊疗操作是感染的主要诱因。结论颅脑手术后合理应用广谱抗菌药物及肾上腺糖皮质激素类药物,是预防医院真菌感染的重要环节。真菌感染的临床表现常不典型,对于颅脑手术后重症患者且需长时间使用抗菌药物者,应预防性使用抗真菌药物;已并发真菌感染者应选用合适的抗真菌药物治疗,治疗宜早期、足量、足疗程。

Objective To explore the risk factors,clinical characteristics,prevention and treatment of fungal infec tions in severe patients after craniotomy. Methods Clinical data of 27 severe patients with fungal infections after craniotomy in neurosurgery department in a hospital between January 2009 and June 2011 were analyzed retrospectively. Results Of 27 patients, 12 cases had lung fungal infections, 8 had urinary tract infections, 4 had gastrointes final tract infections, 2 had surgical site infections, and I had bloodstream infections; 22 cases improved or cured, 1 died, 4 patients gave up treatment and were discharged. The major risk factors for {ungal infections in postoperative severe patients were coma, application of broad-spectrum antimicrobial agents and glucocorticoids, and a variety of invasive treatment operation. Conclusion The key to the prevention of nosocomial fungal infection after craniotomy is the rational use of broad-spectrum antimicrobial agents and glucocorticoids. The clinical manifestations of fnngal infections are not typical. For postoperative severe patients who require longterm use of antimicrobial agents, antifungal agents should be used preventively; Patient who has fungal infection should choose appropriate antifungal agents, antifungal agents should be used early, enough and full course.