肝胆外科病房深部真菌感染调查及其危险因素分析

Risk factors for deep fungal infections in hepatobiliary surgery surgical wards

目的探讨肝胆外科病房真菌感染的临床特点与危险因素。方法收集2005年1月-2010年6月肝胆外科病房深部真菌感染63例患者的临床资料,回顾性分析深部真菌感染的临床特点及危险因素。结果 63例患者留样标本共分离出76株真菌,深部真菌感染以白色假丝酵母菌为主,占47.4%,>2种真菌混合感染者为13.1%;深部真菌感染的疾病主要有重症急性胰腺炎、肝胆胰恶性肿瘤、急性梗阻性胆管炎;长期广谱抗菌药物及皮质类固醇激素的使用、机械通气、中心静脉置管、静脉高营养的使用、肝功能障碍、高龄(≥60岁)等是肝胆外科病房深部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;合理使用抗菌药物、减少侵入性操作、加强无菌观念和增强机体抵抗力是防止深部真菌感染的有效措施。

OBJECTIVE To investigate the clinical features and risk factors for deep fungal infections in the hepatobiliary surgical wards.METHODS The clinical data of 63 patients with fungal infections in hepatobliliary surgery wards were reviewed and the characteristics and risk factors were retrospectively analyzed.RESULTS There were totally 76 strains of fungi isolated from 63 patients,Candida albicans isolates were the major strains causing deep fungal infections,accounting for 47.4%;the patients infected with more than two species of fungi accounted for 13.1%;the severe acute pancreatitis,hepatobiliary and pancreatic cancer,acute obstructive cholangitis were the top three underlying diseases;long-term use of broad-spectrum antibiotics and corticosteroids,mechanical ventilation,central venous catheterization,intravenous nutrition,liver dysfunction,and the advanced age（more than 60 years） were the risk factors for the deep fungal infections in hepatobiliary surgical wards.CONCLUSION The deep fungal infections are the common complications in hepatobiliary surgery wards;to reasonably use antibiotics,reduce the invasive operations,intensify the sterilization cognition,and enhance the body immunity is the effective measure to prevent deep fungal infections.