慢性阻塞性肺疾病继发肺部真菌感染诊治与分析

Diagnosis and treatment of chronic obstructive pulmonary disease with secondary pulmonary fungal infections

目的探讨慢性阻塞性肺疾病继发肺部真菌感染的临床诊断、治疗方法以及影响的相关因素,以达到控制病情的发展和降低感染的目的。方法采取回顾性的方法对2009年2月-2010年2月收录的60例慢性阻塞性肺疾病继发肺部真菌感染患者的临床资料进行分析。结果慢性阻塞性肺疾病继发肺部真菌感染的发生主要与广谱抗菌药物和糖皮质激素使用不当等相关因素有着直接的联系;感染的真菌主要为白色假丝酵母菌、热带假丝酵母菌、克柔假丝酵母菌和曲霉菌属,分别占62.5%、15.0%、13.8%、8.7%;60例患者中有57例痊愈或好转,占95.0%,2例患者自动出院,1例治疗无效死亡。结论正确的指导慢性阻塞性肺疾病患者的用药,是避免肺部真菌感染的重要措施,患者一旦确诊有肺部真菌感染,应严格的按照临床用药标准,合理地选取药物进行治疗。

OBJECTIVE To explore the measures for clinical diagnosis and treatment of chronic obstructive pulmonary disease （COPD） with secondary pulmonary fungal infections and analyze the related risk factors so as to control the disease and reduce the incidence of infections. METHODS The clinical data of 60 cases of COPD patients with secondary pulmonary fungal infections who were enrolled the hospital from Feb 2009 to Feb 2010 were retrospectively analyzed. RESULTS The incidence of secondary pulmonary fungal infections in the COPD patients was directly related to the improper use of broad-spectrum antibiotics or corticosteroids. The Candida albicans, Candida tropicalis, Candida lerusei, and Aspergillus were the main species of fungi causing the infections, accounting for 62.5%, 15.0%, 13.8%, and 8.7%, respectively. Of totally 60 patients, 57 （95.0%） patients were cured or improved, 2 cases were discharged voluntarily, and 1 patient died. CONCLUSION Correct guidance for medication is an important measure to prevent pulmonary infections in the patients with COPD; once the patients are diagnosed as the pulmonary infections, it is necessary to reasonably use antibiotics in accordance with criteria of clinical medication.