重症脑血管病病人并发肺部真菌感染的高危因素

THE RISK FACTORS OF PULMONARY FUNGAL INFECTION IN PATIENTS WITH SEVERE CEREBROVASCULAR DISEASE

目的:探讨重症脑血管病病人并发肺部真菌感染的高危因素。方法:分析我院2013-01~2016-12重症医学科收治的109例重症脑血管病(均需机械通气),且合并肺部感染病人的临床资料,对其并发肺部真菌感染的高危因素进行统计分析。结果:65例痰标本未检测到真菌,占59.6%,44例痰标本显示合并肺部真菌感染的病人均为假丝酵母菌属感染,尤以白色假丝酵母菌居多,占22.9%,其次是热带假丝酵母菌,占14.7%。统计结果显示:重症脑血管病病人并发肺部真菌感染与病人的年龄、GCS评分、糖尿病、基础肺病、入住ICU时间、呼吸机使用时间、纤支镜检查次数及APACHEⅡ评分具有相关性(P<0.05),且与预后显著相关(P<0.01),而与病人的性别、吸烟及冠心病无相关性(P>0.05);44例重症脑血管病合并肺部真菌感染的病人经积极治疗后,好转35例,占79.5%;病情严重死亡9例,占20.5%,而9例死亡的病人中,白色假丝酵母菌感染者只有1例。结论:加强对高龄伴意识障碍脑血管病病人的气道管理、调控血糖,争取尽早脱机拔管离开ICU,尽量减少呼吸道侵入性操作,对预防重症脑血管病人并发肺部真菌感染具有重要的临床意义;重症脑血管病合并肺部真菌感染,以假丝酵母菌属感染为主,而死亡的病人则以非白色假丝酵母菌感染者居多。

Objective：To investigate the risk factors of pulmonary fungal infection in patients with severe cerebrovascular disease.Methods： Analysis of the clinical data about 109 patients with severe cerebrovascular disease who were required mechanical ventilation and complicated with pulmonary in-fection was carried out at the Department of critical care medicine from January 2013 to December 2016 in our hospital,and analyzed statistically the risk factors of pulmonary fungal infection. I＇esults：Fungi were not detected in sputum samples of 65 patients, accounting for 59.6%.44 cases of sputum showed that all patients with pulmonary fungal infection were Candida infection , in particular , the majorityCandida albicans accounting for 22.9%,followed by Candida tropicalis accounting for 14.7%.Statistical findings indicate that patients with severe cerebrovascular disease complicated with pulmonary fungal infection was correlated with age,GCS scores, diabetes,basal lung disease,check in time at ICU, venti- lator use time,the number of using fiberoptic bronchoscopy and APACHE I I scores（P〈0.05） ,and sig-nificant correlation with prognosis （P〈0.01） , there was no correlation with gender, smoking andcoronary heart disease （P〉0.05 ） . 44 cases of severe cerebrovascular disease complicated withpulmonary fungal infection,after active treatment, improved in 35 cases accounting for 79.5 % , 9 cases die accounting for 20.5% , among the 9 patients who died Candida albicans were only To strengthen the airway management about of the elderly patients with cerebrovascular disease and with disorders of consciousness, control of blood glucose, stop mechanical ventilation and remove endo- tracheal tube and leave from ICU as early as possible,reduce respiratory tract invasive operation,to pre-vent of severe cerebrovascular patients with pulmonary fungal infection has important cance. Candida infection is the main in severe cerebrovascular disease complicated gal infection, Candida albicans infection is a small cause of death.