重症颅脑损伤患者气管切开术后肺部真菌感染因素的分析

Analysis of pulmonary fungal infection after tracheotomy in patients with severe craniocerebral injury

目的研究重症颅脑损伤患者气管切开术后肺部真菌感染因素。方法选取本院2017年2月至2019年1月收治的重症颅脑损伤行气管切开术后发生肺部真菌感染患者60例作为研究组,未发生肺部真菌感染患者94例作为对照组。分析研究组引发肺部真菌感染的类型,通过组间对比,分析研究组患者发生肺部真菌感染的高危因素。结果从检测结果分析,患者肺部真菌感染最多的为白色假丝酵母菌,检出率36.67%;其次为光滑假丝酵母菌,占比30.00%;第3是热带假丝酵母菌,占比23.33%。两组低蛋白血症、入院GCS评分(<8分)、通气辅助时间(≥7 d)、抗菌药物使用时间(≥14 d)、使用全身糖皮质激素、使用碳青霉烯类药物等指标比较差异有统计学意义(P<0.05)。结论重症颅脑损伤气管切开术后肺部真菌感染最多见的为白色假丝酵母菌。低蛋白血症、入院GCS评分(<8分)、通气辅助时间(≥7 d)、抗菌药物使用时间(≥14 d)、使用全身糖皮质激素、使用碳青霉烯类药物等均是引发重症颅脑损伤气管切开术后肺部真菌感染的高危因素。针对这些高危因素进行提前预防,可以降低肺部真菌感染的发生率。

Objective To investigate the factors of pulmonary fungal infection after tracheotomy in patients with severe craniocerebral injury.Methods A retrospective study was conducted on 60 patients with severe craniocerebral injury treated in our hospital from February 2017 to January 2019 who developed pulmonary fungal infection after tracheotomy and 94 patients without pulmonary fungal infection as the control group.The types of pulmonary fungal infection in the study group were analyzed,and the high risk factors of pulmonary fungal infection in the study group were analyzed through the comparison between groups.Results According to the analysis of the detection results,candida albicans was the most common pulmonary fungal infection in the patients,with a detection rate of 36.67%;followed by Candida smooth,accounting for 30.00%;the third is candida tropicalis,accounting for 23.33%.There were statistically significant differences between the two groups in terms of hypoproteinemia,admission GCS score(<8 scores),ventilator-assisted time(≥7 d),duration of antibacterial drug use(≥14 d),systemic glucocorticoid use,and carbapenems use(P<0.05).Conclusion Candida albicans is the most common pulmonary fungal infection after tracheotomy for severe craniocerebral injury.Hypoproteinemia,admission GCS score(<8 scores),ventilator-assisted time(≥7 d),antimicrobial use time(≥14 d),systemic glucocorticoid,and carbapenems were all high risk factors for pulmonary fungal infection after tracheotomy with severe craniocerebral injury.Preemptive prevention against these risk factors can reduce the incidence of pulmonary fungal infection.