外科手术后真菌感染的易患因素分析及防治对策

Analysis on Risk Factors and Preventive Countermeasures of Fungal Infection in Patients After Surgery

目的探讨外科术后真菌感染的易感因素及防治对策。方法选取本院腹部手术后发生真菌感染患者102例作为真菌感染组,随机选择同期腹部术后未发现真菌感染患者416例作为对照组,回顾性分析和比较两组患者的临床资料,概括术后真菌感染的易感因素及防治对策。结果多元Logistic回归分析显示与术后真菌感染相关的因素有年龄、住院时间、抗生素使用时间、机械通气、激素应用、白细胞计数、侵袭性操作、肝功能障碍及合并糖尿病等(年龄≥60岁:P=0.045,OR=1.385;住院时间≥30 d:P=0.027,OR=1.584;广谱抗生素使用≥14 d:P=0.031,OR=5.463;机械通气:P=0.003,OR=0.086;皮质类固醇激素:P=0.018,OR=6.471;白细胞<4.0×109/L:P=0.000,OR=9.756;侵袭性操作:P=0.002,OR=7.524;糖尿病:P=0.000,OR=0.033;肝功能障碍:P=0.039,OR=0.394)。白假丝酵母菌为主要致病菌(59株,57.8%),主要发生于呼吸道(46例,45.1%)。结论严格遵守抗生素及皮质类固醇激素使用原则,积极治疗基础疾病,规范侵入性操作过程,严格落实消毒隔离制度,加强一般及留置导管的专项护理等医疗及护理对策,将对术后真菌感染实现有效的预防。

Objective To explore the r/sk factors and prevention and control measures of fungal infection in patients undergoing surgery. Methods One hundred and two patients who had fungal infection after abdominal surgery were chosen as fungal infection group and 416 patients after abdominal surgery with no fungal infection were simultaneously selected as the control group at random. After comparing and retrospectively analyzing clinical data of the two groups, we summarized the risk factors and prevention and control measures of fungal infection. Results Multivariate Logistic regression analysis showed that risk factors of fungal infection after abdominal surgery included： age, length of stay, use of antibiotics, mechanical ventilation, corticosteroid application, white blood cell count, invasive operation, liver dysfunction and diabetes meUitus suffered （aged 60 years or over： P = 0. 045, OR = 1. 385 ; hospital stay^30 days： P = 0. 027, OR = 1. 584; use of antibiotics≥ 14 days： P = 0. 031, OR = 5. 463; mechanical ventilation： P = 0. 003, OR = 0. 086; corticosteroid application： P = 0. 018, OR = 6. 471 ; white bkxxi cell count〈 4.0 ×10^9/L： P = 0. 000, OR = 9. 756 ; invasive operation： P = 0. 002, OR = 7. 524 ; diabetes mellitus： P = 0. 000, OR = 0. 033 ; liver dysfunction： P = 0. 039, OR = 0. 394）. Candida albicans was the major oathogen （59 strains.57.8 % ）, and mainly occurred in the respiratory tract （46 cases, 45.1% ）. Conclusions In order to prevent postoperative fungal infections effectively, we should comply with the using principle of antibiotics and corticosteroids strictly, treat with under- lying diseases actively, regulate invasive procedures, strictly implement the disinfection and isolation system and enhance the general and special catheter nursing care.