ICU重症患者肺部真菌感染的临床分析

Clinical characteristics of critically ill patients with pulmonary fungal infections in ICU

目的研究重症监护病房(ICU)患者肺部真菌感染的临床特点,为临床治疗提供参考。方法选取2011年1月-2013年1月ICU诊治的120例肺部真菌感染患者,回顾性分析其临床资料,总结患者的临床感染症状与体征、感染部位及真菌种类分布,并对引发肺部真菌感染的危险因素进行分析,采用SPSS16.0统计软件对数据进行处理,计量资料采用t检验,计数资料采用χ2检验。结果 120例ICU患者的症状与体征中以发热居多113例占94.17%,其次为肺部湿啰音63例占52.50%,痰量增多、黏稠61例占50.83%;经痰液、肺部分泌物及血液等标本中共分离出真菌133株,其中以白色假丝酵母菌为主78株占58.65%;其次为热带假丝酵母菌22株占16.54%、光滑假丝酵母菌14株占10.52%;长期应用糖皮质激素及免疫抑制剂、≥2种广谱高效抗菌药物应用>1周、气管插管和气管切开、低蛋白血症、白细胞降低、入住ICU住院时间>1周均为ICU患者并发肺部真菌感染的危险因素,其中≥2种广谱高效抗菌药物应用>1周患者感染率最高,为64.17%。结论 ICU重症患者肺部真菌感染临床症状与体征主要是发热、肺部湿啰音、痰量增多黏稠,感染的真菌以白色假丝酵母菌居多,≥2种广谱高效抗菌药物应用>1周是引发ICU患者肺部真菌感染的最主要危险因素。

OBJECTIVE To study the clinical characteristics of the critically ill patients with pulmonary fungal infections in intensive care unit （ICU） so as to provide guidance for the clinical treatment. METHODS A total of 120 patients with pulmonary fungal iiffections, who were treated in the ICU from Jan 2011 to Jan 2013, were enrolled in the study, then the clinical data were retrospectively analyzed, the clinical symptoms of infections, signs, infection sites, and distribution of species of fungi were observed, the risk factors for the pulmonary fungal infections were analyzed, the data were statistically analyzed with the use of SPSS16.0 software, the t-test was conducted for the measurement data, and the chi-square test was carried out for the count data. RESULTS Among all the clinical symptoms and signs of the 120 ICU patients, there were 113 （94. 17~//00） cases of fever, 63 （52.50%） cases of pulmonary moist rales, and 61 （50. 83%） cases of increased sputum volume and viscosity. Totally 133 strains of fungi have been isolated from the sputum, pulmonary secretions, and blood specimens, including 78 （58.65~） strains of Candida albicans, 22 （16.54~） strains of C. ＂tropicalis, and 14 （10. 52~） strains of C. glabrata. The long term use of corticosteroids and immunosuppressants, use of more than 2 broad spectrum antimicrobial agents for more than 1 week, endotracheal intubation, tracheotomy, hypoalbuminemia, and length of ICU stay for more than 1 week were the risk factors for pulmonary fungal infections in the ICU patients; the infection rate was highest in the patients who used more than 2 broad spectrum antibiotics for more than 1 week. CONCLUSION The main clinical symptoms and signs of the critically ill patients with pulmonary fungal infections include the fever,pulmonary moist rales, increased sputum volume and viscosity; the C. albicans is dominant among the fungi causing the infections; the use of more than 2 broad spectrum antibiotics for more than 1 week is the predominant risk factor for the pulmonary fungal infections in the ICU patients