呼吸机相关性肺炎下呼吸道真菌定植的危险因素分析

RISK FACTORS OF LOW RESPIRATORY TRACT FUNGAL COLONIZATION IN PATIENTS WITH VENTILATOR ASSOCIATED PNEUMONIA

目的 初步探讨呼吸机相关性肺炎 (VAP)下呼吸道真菌定植的危险因素。方法 回顾性分析本院综合ICU收治 5 8例VAP患者下呼吸道真菌定植的流行病学资料 ,根据真菌培养结果将患者分为真菌定植组和非真菌定植组 ,分析VAP患者下呼吸道真菌定植的危险因素。结果 在 2 7例患者的下呼吸道分泌物中培养出真菌 3 1株 ,VAP真菌定植率为 46.6%。以白色念珠菌最多 ,占 71%。真菌定植组与非真菌定植组在是否使用激素及强力广谱抗生素方面有显著性差异 (P <0 0 5 ) ,而在性别组成、年龄、入ICU后 2 4h的APACHEⅡ评分以及是否存在糖尿病方面均无明显差异 (P >0 0 5 ) ;真菌定植组的机械通气时间明显延长 (P <0 0 5 ) ,而 2组的MODS发生率及死亡率无明显差异 (P >0 0 5 )。结论 在VAP患者中下呼吸道真菌定植非常普遍 ,前期使用激素及强力广谱抗生素是主要危险因素 ,如出现VAP ,要警惕下呼吸道真菌定植的发生。

Objective: To investigate the risk factors of low respiratory tract fungal colonization in ventilator associated pneumonia (VAP). Methods: The epidemiological data of low respiratory tract fungal colonization were collected from 58 VAP patients who were treated in our department.They were divided into fungal colonization group and non-fungal colonization group according to the results of fungi culture. Risk factors were compared and analyzed between the two groups. Results: 31 strains of fungi were isolated from low respiratory tract in 27 out of 58 patients,accounting for 46.6% of VAP patients. Candida albicans was at most in fungal(71%). There was statistically significant difference in whether potent antibiotics with broad spectrum and glucocorticosteroid had been used between the two groups ( P <0.05),while no statistically significant difference was found in age,sex,APACHEⅡscores and whether the patients have diabetes ( P >0.05). There was statistically significant difference in the time required for respirator application between the two groups ( P <0.05),while no statistically significant difference was found in hospital mortality or MODS ( P >0.05). Conclusion: Low respiratory tract fungal colonization is quite prevalent in VAP patients. Prior administration of potent antibiotics with broad spectrum and glucocorticosteroid is the main risk factor.