高龄肺癌患者真菌性肺炎的临床调查研究

Clinical research study of elderly patients with lung fungal pneumonia

目的调查研究高龄肺癌患者发生真菌性肺炎临床特点,为临床治疗预防提供参考,以降低真菌性肺炎所致的病死率。方法选取2009年3月-2013年11月128例发生真菌性肺炎的老年肺癌患者,采集其痰液标本进行培养,检测真菌分布;及时使用抗真菌药物治疗,治疗维持4周,并于治疗后再次进行真菌检测及复查CT,分析患者临床特征、真菌分布及治疗后转归。结果老年肺癌发生真菌性肺炎患者感染痰标本中共分离出真菌128株,其中白色假丝酵母菌80株,占62.5%;胸部影像学表现以斑片状阴影最多,占68.8%;所有患者均患有冠心病;主要临床表现为发热及咳嗽,分别占79.7%及99.2%;患者均使用抗菌药物治疗,治愈率为81.3%,病死率为18.7%,死亡原因主要为呼吸衰竭。结论高龄肺癌患者真菌感染率高,易导致重症肺炎,临床应合理用药,加强对感染预防控制。

OBJECTIVE To investigate the clinical characteristics of fungal pneumonia in elderly patients with lung cancer ,so as to provide reference for clinical prevention , and to reduce mortality due to fungal pneumonia . METHODS A total of 128 cases of elderly patients with fungal pneumonia were selected from Mar .2009 to Nov . 2013 ,and their sputum samples were cultured and tests were conducted to detect pathogens distribution .Antifun‐gal therapy was adopted timely ,and the treatment continued for 4 weeks .After the treatment ,pathogen detection and CT review were implemented again to analyze the clinical characteristics ,distribution of fungi and disease outcome of the patients .RESULTS Totally 128 strains of fungi pathogens were isolated from the sputum samples of elderly patients with lung cancer occurred fungal pneumonia .Among them ,there were 80 strains of white Candi‐da albicans ,accounting for 62 .5% .The chest images manifested as patchy shadows most ,accounting for 68 .8% ;All patients suffered from coronary heart disease with the main clinical manifestation as fever and cough , accounting for 79 .7% and 99 .2% respectively .All patients had treated with antibiotics and the cure rate was 81 .3% while the fatality rate was 18 .7% .The main cause for the death was respiratory failure .CONCLUSION Elderly patients with lung cancer have high incidence of fungal infections , which can easily lead to severe pneumonia .The clinical rational use of drug should be strengthened and measures should be reinforced to prevent and control the infections .