肿瘤重症患者侵袭性肺部真菌感染的危险因素分析

Analysis of Risk Factors for Invasive Pulmonary Fungal Infection in Pa⁃tients with Severe Tumor

目的 分析肿瘤重症患者侵袭性肺部真菌感染的危险因素。方法 选择2022年2月—2023年2月内蒙古医科大学附属肿瘤医院收治的180例肿瘤重症患者,根据是否发生侵袭性肺部真菌感染对患者进行分组,将患者分为感染组和非感染组,分别有29例和151例,对所有患者进行回顾性调查,使用单因素和多因素分析侵袭性肺部真菌感染的危险因素。结果 180例肿瘤重症患者中,发生侵袭性肺部真菌感染患者有29例,发病率为16.11%;感染组和非感染组广谱抗生素应用时间>2周和种类>2种、机械通气、气管插管和切开、深静脉置管、骨髓抑制等差异有统计学意义(P<0.05);多因素Logistic回归分析结果显示,广谱抗生素应用时间>2周、广光谱抗生素应用种类>2种、机械通气、气管插管、气管切开、深静脉置管、使用糖皮质激素、骨髓抑制是肿瘤重症患者侵袭性肺部真菌感染发生的危险因素(OR=6.463、5.703、6.973、6.162、4.241、4.064、3.631、6.735)。结论 肿瘤重症患者侵袭性肺部真菌感染的发生与机械通气、气管插管、气管切开、深静脉置管、使用糖皮质激素、广谱抗生素应用和骨髓抑制等有关,为预防感染发生,除积极对原发病进行治疗之外,应根据危险因素采取针对性预防措施。

Objective To analyze the risk factors of invasive pulmonary fungal infection in patients with severe tumor.Methods A total of 180 patients with severe tumor admitted to the Affiliated Cancer Hospital of Inner Mongolia Medi‐cal University from February 2022 to February 2023 were selected.Patients were grouped according to whether inva‐sive pulmonary fungal infection occurred,and the patients were divided into infected and non-infected groups,with 29 and 151 cases,respectively.All patients were retrospectively investigated and risk factors for invasive pulmonary fungal infection were analyzed using univariate and multifactorial analyses.Results Among 180 patients with severe tumor,29 cases developed invasive pulmonary fungal infection(16.11%).The application time of broad-spectrum anti‐biotics>2 weeks and type>2 kinds,mechanical ventilation,tracheal intubation and incision,deep vein catheteriza‐tion,bone marrow suppression were statistically significant difference between infected and non-infected groups(P<0.05).The results of multivariate Logistic regression analysis showed that broad-spectrum antibiotics were used for>2 weeks,broad-spectrum antibiotics were used for>2 kinds,mechanical ventilation,tracheal intubation,tracheotomy,deep vein catheterization,glucocorticoid use,and bone marrow suppression were the risk factors for invasive pulmo‐nary fungal infection in patients with severe tumor(OR=6.463,5.703,6.973,6.162,4.241,4.064,3.631,6.735).Con-clusion The occurrence of invasive pulmonary fungal infection in severe tumor patients is related to mechanical venti‐lation,tracheal intubation,tracheotomy,deep vein catheterization,use of glucocorticoids,application of broad-spectrum antibiotics,and bone marrow suppression,etc.In order to prevent infection,in addition to active treatment of the primary disease,targeted preventive measures should be taken according to the risk factors.