重症监护病房呼吸机相关性肺部真菌感染的危险因素分析

Analysis of risk factors of ventilator-associated pulmonary fungal infection in intensive care unit

目的探讨重症监护病房(intensive care unit,ICU)真菌致呼吸机相关性肺炎的危险因素,为预防呼吸机相关性肺部真菌感染的发生提供客观依据。方法回顾性分析温州医科大学附属苍南医院和平阳县人民医院ICU近3年来呼吸机导致相关性肺炎(ventilator associated pneumonia,VAP)患者99例的临床资料,分为肺部真菌感染组26例和非真菌感染组73例,比较分析肺部真菌感染的危险因素,单因素分析采用χ~2检验,多因素分析采用Logistic回归分析。结果年龄(≥60岁)、机械通气时间(≥7 d)、合并糖尿病、住院时间(≥7 d)、使用糖皮质激素、合并细菌感染、低蛋白血症(≤35 g/L)、多联抗生素的使用和频繁更换(>2次/周)是导致真菌性呼吸机相关性肺炎(Fungal ventilator associated pneumonia,FVAP)的主要危险因素。其中年龄(≥60岁)、机械通气时间(≥7 d)、住院时间(≥7 d)、合并细菌感染、低蛋白血症(≤35 g/L)、多联抗生素的使用是引起FVAP的独立危险因素。结论真菌性呼吸机相关性肺炎(FVAP)患者继发真菌感染以白色假丝酵母菌和曲霉菌属为常见;引起FVAP的危险因素较为复杂,临床应加强危险因素监测,同时要严格无菌操作,尽可能缩短机械通气时间,可有效控制FVAP的发生。

Objective To explore the risk factors of ventilator-associated pneumonia caused by fungi in ntensive care unit（ICU）, and to provide objective evidence for the prevention of ventilator-associated pulmonary fungal infection. Methods The clinical data of 99 cases of ventilator associated pneumonia（VAP） in ICU in Wenzhou Medical University Affiliated Cangnan Hospital and Pingyang People＇s Hospital were analyzed retrospectively. The patients were divided into pulmonary fungal infection group（n=26） and non-fungal infection group（n=73）. The risk factors of pulmonary fungal infection were compared. Univariate analysis was performed by X2 test. Multivariate analysis was performed by Logistic regression analysis. Results Age（≥60 years old）, mechanical ventilation time（≥7 d）, combination of diabetes mellitus, hospital stay（≥ 7 d）, the use of glueocortieoids, combination of bacterial infection, hypoproteinemia（≤35 g/L）, the use of multiple antibiotics and frequent replacement （〉2 times/week） were the major risk factors for fungal ventilator as sociated pneumonia（FVAP）. Among them, the age（≥60 years old）, mechanical ventilation time（≥7 d）, hospital stay （≥ 7 d）, combination of bacterial infection, hypoproteinemia（≤ 35 g/L）, the use of multiple antibiotics were the imlepen- dent risk factors of FVAP. Conclusion The Candida albicans and Aspergillus are common in patients with FVAP sec- ondary fungal infections. The risk factors of FVAP are complicated. At the same time the aseptic operation should be strictly performed and the mechanical ventilation time should be shortened as much as possible, which can effectively control the occurrence of FVAP.