慢性心力衰竭患者肺部真菌感染病原学分析与治疗研究

Etiological analysis of pulmonary fungal infections in patients with chronic heart failure and treatment research

目的：探讨慢性心力衰竭患者发生肺部真菌感染的病原菌分布，且加强预防控制措施，以降低感染的发生，控制病情进展。方法回顾性分析2010年1月－2013年12月56例慢性心力衰竭发生肺部真菌感染患者临床资料，采用纸片扩散法进行细菌培养和药敏试验，进行病原学分析，并总结预防治疗措施，研究数据采用SPSS13．0软件进行统计处理。结果56例慢性心力衰竭发生肺部真菌感染患者痰培养中，共分离出真菌63株，其中以白色假丝酵母菌为主，占26．98％，其次为都柏林假丝酵母菌、近平滑假丝酵母菌，分别占19．05％、17．46％；所有真菌对两性霉素B的耐药性均为0，而对伏立康唑、卡泊芬净的耐药率在5．88％～37．50％；但克柔假丝酵母菌对伊曲康唑耐药率仅为22．21％；慢性心力衰竭发生肺部真菌感染患者予以预防治疗措施后，治愈率为55．36％，总有效率73．21％。结论慢性心力衰竭发生肺部感染患者真菌耐药性较严重，在临床加强预防治疗措施后，可取得一定的临床效果。

OBJECTIVE To investigate the pathogen distribution of pulmonary fungal infections secondary to chronic heart failure ,and to strengthen the prevention and control measures to reduce the incidence of infections and control of disease progression .METHODS A retrospective analysis was conducted on clinical data of 56 cases of chronic heart failure with secondary pulmonary fungal infections in Jan .2010 to Dec .2013 ,the bacterial culture and sensitivity testing were conducted using the disk diffusion method ,and the etiology analysis was performed and prevention measures were summarized .The software SPSS13 .0 was used for statistical analysis of data . RESULTS From sputum culture of the 56 patients ,63 fungal strains were isolated ,mainly including Candida albi‐cans accounting for 26 .98% ,followed by Candida dubliniensis （19 .05% ） and Candida parapsilosis （17 .46% ） . All fungi had no resistance to amphotericin B and 5 .88% ~37 .50% resistance to voriconazole and caspofungin , however ,the resistance of C .krusei to itraconazole was only 22 .21% .After preventive treatment for patients with pulmonary fungal infections secondary to chronic heart failure ,the cure rate was 55 .36% and the total efficiency was 73 .21% .CONCLUSION Pulmonary fungal infections secondary to chronic heart failure have more serious resistance .After strengthening preventive measures ,certain clinical achievements can be obtained .