80岁及以上老年患者医院感染真菌性肺炎的临床分析

The clinical analysis of patients aged ≥ 80 years with hospital infection of mycotic pneumonia

目的观察年龄≥80岁患者医院感染真菌性肺炎的临床特点并进行综合分析。方法2007年6月至2011年7月住院的64例医院感染真菌性肺炎老年患者，年龄80～93岁，平均85．6岁。收集临床资料，根据痰培养结果制订治疗方案，选择敏感的抗细菌药物。同时进行疗效判定。结果64例医院感染真菌性肺炎患者痰培养中以白色假丝酵母菌占首位（62．5％，40例），其次为光滑假丝酵母菌（20．3％，13例），二者比较差异有统计学意义（x2=127．50，P〈0．01）；胸部x线或CT片缺乏特异性，但片状阴影（68．8％，44例）和团絮状阴影（40．6％，26例）占多数；60例（93．8％）患者同时合并3种以上的疾病；58例（90．6％）曾应用2种以上抗生素；治愈率81．3％（52例），病死率18．8％（12例）。结论年龄80岁及以上患者医院感染真菌性肺炎发生率增高，病死率高，治愈的关键是及早确诊、及早治疗。

Objective To analyze the clinical characteristics of hospital acquired mycotic pneumonia in elderly patients （aged≥ 80 years）. Methods The clinical data were reviewed on 64 cases of elderly patients aged 80-93 years with hospital acquired infection of mycotic pneumonia from June 2007 to July 2011. According to the results of sputum culture, therapy plan was made and antibiotic drugs were selected. Results Among these 64 patients,Candida mycoderma （62.5 % ,40 cases） occupied the first place and C. glabrata （20.3% , 13 cases） was the second place （x2 = 127.50, P〈0.01）. Their chest x-ray or CT films were not characteristic, but lamellar shadows （68.8% ,44 cases） and cotton-like shadows （40.6%,26 cases） were found in the majority. 60 cases（93.8%）of these patients had more than 3 complications, and 58 cases（90.6%）of them took over 2 kinds of antibiotics. The improvement rate of these patients was 81.3% （52 cases）and mortality rate was 18.8%（12 cases）. Conclusions Elderly patients （aged≥ 80 years） with hospital acquired infection of mycotic pneumonia have high incidence and mortality rate. The key point to cure is to make an early diagnosis and treat them as early as possible.