老年慢性阻塞性肺疾病急性加重合并Ⅱ型呼吸衰竭病人肺部真菌感染危险因素分析

Risk factors of pulmonary fungal infection in elderly patients with acute exacerbation of chronic obstructive pulmonary disease complicated with type Ⅱ respiratory failure

目的探讨老年慢性阻塞性肺疾病(COPD)急性加重合并Ⅱ型呼吸衰竭病人肺部真菌感染的危险因素。方法以2014年10月至2016年7月我院收治的110例老年COPD急性加重合并Ⅱ型呼吸衰竭病人为研究对象,调查病人合并肺部真菌感染的发生率,依据病人是否合并肺部真菌感染将其分为感染组及未感染组,比较2组一般资料,采用多因素Logistic回归进一步探究影响病人肺部真菌感染的高危因素。结果 110例老年COPD急性加重合并Ⅱ型呼吸衰竭病人中有50例病人合并肺部真菌感染,肺部真菌感染率为45.45%;感染组COPD分级(3、4级)、合并糖尿病、使用糖皮质激素、长期使用抗菌药物、既往有机械通气、既往有侵入性操作百分比以及住院时间显著高于未感染组,差异有统计学意义(P<0.05);多因素Logistic分析显示合并糖尿病、使用糖皮质激素、长期使用抗菌药物、既往有机械通气及侵入性操作是老年COPD急性加重合并Ⅱ型呼吸衰竭病人肺部真菌感染的独立危险因素(P<0.05)。结论老年COPD急性加重合并Ⅱ型呼吸衰竭病人合并肺部真菌感染发生率较高,而合并糖尿病、使用糖皮质激素、长期使用抗菌药物、既往有机械通气及侵入性操作为其独立危险因素,临床可据此为病人实施合理的防治措施。

Objective To investigate the risk factors of pulmonary fungal infection in elderly patients with acute exacerbation of chronic obstructive pulmonary disease（ AECOPD） complicated with type Ⅱ respiratory failure. Methods A total of 110 elderly patients with AECOPD complicated with typeⅡrespiratory failure treated in our hospital from October 2014 to July 2016 were enrolled in the study. The incidence rate of pulmonary fungal infection was surveyed. According to whether the patients suffered from pulmonary fungal infection,they were divided into the infected group and uninfected group. The risk factors of pulmonary fungal infection were analyzed by univariate and multivariate analysis. Results Among the110 cases of elderly patients with AECOPD combined with respiratory failure,there were a total of 50 patients with pulmonary fungal infection,and the infection rate was 45. 45%. The proportions of the patients with grade 3 and grade 4 COPD,diabetes mellitus,using glucocorticoids,long-term use of antibiotics,long hospital stay,history of mechanical ventilation and history of invasive operation were significantly higher in the infected group than those in the uninfected group（ P0. 05）. Multivariate logistic analysis showed that diabetes mellitus,using glucocorticoids,long-term use of antibiotics,history of mechanical ventilation and invasive operation were independent risk factors for pulmonary fungal infection in elderly patients with AECOPD complicated with type Ⅱ respiratory failure（ P 0. 05）. Conclusions The incidence of pulmonary fungal infection is high in patients with AECOPD complicated with type Ⅱ respiratory failure,and diabetes mellitus,using glucocorticoids,long-term use of antibiotics,history of mechanical ventilation and invasive operation are the independent risk factors.