老年慢性阻塞性肺疾病患者肺部真菌感染的危险因素分析

Risk factors of pulmonary fungal infections in elderly patients with chronic obstructive pulmonary disease

目的探讨老年慢性阻塞性肺疾病患者并发肺部真菌感染的危险因素及相应预防对策,以降低感染率。方法选取老年慢性阻塞性肺疾病并发肺部真菌感染的患者67例及同期未并发肺部感染的患者61例,分别作为观察组和对照组;对两组患者临床治疗经过以及基本资料进行统计和比较。结果观察组患者抗菌药物使用时间(17.15±7.22)d明显长于对照组的(8.39±3.04)d,血清白蛋白水平(28.28±4.60)g/L明显低于对照组的(35.63±3.57)g/L,糖皮质激素应用>2周、合并糖尿病、呼吸衰竭以及使用机械通气的患者均明显高于对照组,两组比较差异均有统计学意义(P<0.05);虽然观察组患者肾功能不全患者多于对照组,但两组差异并不明显,无可比性;经过多因素回归法分析,长期应用抗菌药物、糖皮质激素,合并低白蛋白血症、糖尿病、呼吸衰竭,使用机械通气是引起肺部真菌感染的独立高危因素(P<0.05);67例并发肺部感染的患者中50例(74.63%)为假丝酵母菌属感染,其中尤以白色假丝酵母菌感染最为常见,29例占43.28%;其次是热带假丝酵母菌感染13例占19.40%。结论慢性阻塞性肺疾病患者并发肺部真菌感染,其预后固然与治疗有关,但是预防其发生更为重要,在临床工作中,对老年慢性阻塞性肺疾病患者进行治疗时,应合理应用抗菌药物及糖皮质激素,减少侵入性操作,并积极治疗患者合并疾病,提高患者抵抗力。

OBJECTIVE To study the risk factors of pulmonary fungal infections in elderly patients with chronic obstructive pulmonary disease and put forward corresponding countermeasures so as to reduce the infection rate. METHODS A total of 67 cases of elderly patients with chronic obstructive pulmonary disease complicated with pulmonary fungal infections were selected as the observation group, while 61 cases without pulmonary infections were set as the control group, then the clinical treatment and the basic data were statistically analyzed and compared between the two groups. RESULTS The antibiotic use time of the observation group （17.15± 7.22）d was significantly longer than that of the control group （8.39 ± 3.04）d, the blood albumin level of the observation group was（28.28±4.60） （g/L）, significantly lower than （35.63±3.57） （g/L） of the control group, which was significantly higher in the patients with the use of glucocorticoids more than 2 weeks, the patients complicated with diabetes, the patients with respiratory failure, or the patients who underwent the mechanical ventilation of the observation group than in those of the control group, the difference was statistically significant（P^0.05）. Although the cases with renal dysfunction were more in the observation group than in the control group, the difference was not statistically significant. Multivariate regression analysis showed that the long-term use of antibiotics or corticosteroids, complication of hypoalbuminemia, diabetes, respiratory failure, and use of mechani- cal ventilation were the high-risk independent factors of the pulmonary fungal infections（P〈0.05）. Of totally 67 cases of patients complicated with pulmonary infections, there were 50 （74.63 %） cases with Candida infections, among which 29 （43.28%） cases were with Candida albiean infections, and 13 （19.40%） cases with Candidatropicalis infections. CONCLUSION Although the incidence of pulmonary fungal infections in the patients with chronic obstructive pulmonary disease is related to the treatment, the prevention is even more importance. For the elderly patients with chronic obstructive pulmonary disease, it is necessary to reasonably use antibiotics or eortico- steroids, reduce the invasive operation, actively treat the complications, and improve the immunity of the patients.