中华危重病急救医学
中華危重病急救醫學
중화위중병급구의학
Chinese Critical Care Medicine
2013年
8期
475-478
,共4页
陈志%杨春丽%贺慧为%曾俊
陳誌%楊春麗%賀慧為%曾俊
진지%양춘려%하혜위%증준
制霉菌素%机械通气%侵袭性真菌感染
製黴菌素%機械通氣%侵襲性真菌感染
제매균소%궤계통기%침습성진균감염
Nystatin%Mechanical ventilation%Invasive fungal infections
目的 观察经胃肠道给予制霉菌素对重症监护病房(ICU)机械通气患者侵袭性真菌感染(IFI)发生率及预后的影响.方法 采用前瞻性观察性研究,选择2012年5月1日至2013年4月30日江西省人民医院重症医学科需行有创机械通气的危重症患者,按信封法随机分配至两组,干预组经胃管内注入制霉菌素1000 kU每日3次,对照组给予促进胃肠动力药物作为安慰剂.入组后每隔3d(T0、T3、T6、T9)留取标本,观察分离菌株的分布情况,并计算校正定植指数(CCI),统计念珠菌血症发生率及28 d病死率,记录患者ICU住院时间和总住院时间.结果 共有124例患者入选,共分离出874株菌株,以白色念珠菌居多,占57.6％(503/874),最常见的定植部位为口咽部,占35.6％(311/874).干预组T6、T9时CCI明显低于对照组[T6∶0.19±0.10比0.39±0.15,T9∶0.00(0.10)比0.45(0.30),均P＜ 0.05]；干预组念珠菌血症发生率较对照组有所降低[5.0％(3/60)比7.8％(5/64),P＞0.05],28 d病死率明显低于对照组[18.3％(11/60)比34.4％(22/64),P＜ 0.05].干预组ICU住院时间明显短于对照组(d∶9.56±3.47比11.89±6.32,P＜0.05),但总住院时间(d∶18.35±7.42比20.58±8.77)无明显统计学差异(P＞0.05).结论 经胃肠道给予制霉菌素片能减少ICU危重症患者白色念珠菌定植发生,缩短患者ICU住院时间.
目的 觀察經胃腸道給予製黴菌素對重癥鑑護病房(ICU)機械通氣患者侵襲性真菌感染(IFI)髮生率及預後的影響.方法 採用前瞻性觀察性研究,選擇2012年5月1日至2013年4月30日江西省人民醫院重癥醫學科需行有創機械通氣的危重癥患者,按信封法隨機分配至兩組,榦預組經胃管內註入製黴菌素1000 kU每日3次,對照組給予促進胃腸動力藥物作為安慰劑.入組後每隔3d(T0、T3、T6、T9)留取標本,觀察分離菌株的分佈情況,併計算校正定植指數(CCI),統計唸珠菌血癥髮生率及28 d病死率,記錄患者ICU住院時間和總住院時間.結果 共有124例患者入選,共分離齣874株菌株,以白色唸珠菌居多,佔57.6％(503/874),最常見的定植部位為口嚥部,佔35.6％(311/874).榦預組T6、T9時CCI明顯低于對照組[T6∶0.19±0.10比0.39±0.15,T9∶0.00(0.10)比0.45(0.30),均P＜ 0.05]；榦預組唸珠菌血癥髮生率較對照組有所降低[5.0％(3/60)比7.8％(5/64),P＞0.05],28 d病死率明顯低于對照組[18.3％(11/60)比34.4％(22/64),P＜ 0.05].榦預組ICU住院時間明顯短于對照組(d∶9.56±3.47比11.89±6.32,P＜0.05),但總住院時間(d∶18.35±7.42比20.58±8.77)無明顯統計學差異(P＞0.05).結論 經胃腸道給予製黴菌素片能減少ICU危重癥患者白色唸珠菌定植髮生,縮短患者ICU住院時間.
목적 관찰경위장도급여제매균소대중증감호병방(ICU)궤계통기환자침습성진균감염(IFI)발생솔급예후적영향.방법 채용전첨성관찰성연구,선택2012년5월1일지2013년4월30일강서성인민의원중증의학과수행유창궤계통기적위중증환자,안신봉법수궤분배지량조,간예조경위관내주입제매균소1000 kU매일3차,대조조급여촉진위장동력약물작위안위제.입조후매격3d(T0、T3、T6、T9)류취표본,관찰분리균주적분포정황,병계산교정정식지수(CCI),통계념주균혈증발생솔급28 d병사솔,기록환자ICU주원시간화총주원시간.결과 공유124례환자입선,공분리출874주균주,이백색념주균거다,점57.6％(503/874),최상견적정식부위위구인부,점35.6％(311/874).간예조T6、T9시CCI명현저우대조조[T6∶0.19±0.10비0.39±0.15,T9∶0.00(0.10)비0.45(0.30),균P＜ 0.05]；간예조념주균혈증발생솔교대조조유소강저[5.0％(3/60)비7.8％(5/64),P＞0.05],28 d병사솔명현저우대조조[18.3％(11/60)비34.4％(22/64),P＜ 0.05].간예조ICU주원시간명현단우대조조(d∶9.56±3.47비11.89±6.32,P＜0.05),단총주원시간(d∶18.35±7.42비20.58±8.77)무명현통계학차이(P＞0.05).결론 경위장도급여제매균소편능감소ICU위중증환자백색념주균정식발생,축단환자ICU주원시간.
Objective To observe the effect of nystatin on incidence of invasive fungal infections (IFI) and the prognosis of mechanically ventilated critically ill patients.Methods A prospective study was conducted.Critical ill patients admitted to Department of Critical Care Medicine of Jiangxi Provincial People's Hospital from May I st,2012 to April 30th,2013 needing mechanical ventilation were enrolled.The patients were randomly divided into two groups by envelope method.Patients in the nystatin group were administered nystatin 1000 kU three times a day via the gastric tube; and patients in the control group were given gastrointestinal prokinetic drug as placebo.The specimens were collected every 3 days throughout the ICU stay (T0,T3,T6,T9),the strain distribution was observed,and the corrected colonization index (CCI) of all patients were calculated.The incidence of candidemia and 28-day mortality as well as the duration of stay in ICU and hospital were also recorded.Results A total of 874 strains were isolated from 124 patients,of which Candida albicans accounted for 57.6％ (503/874).The most frequently colonized body sites were oropharyngeal site,account for 35.6％ (311/874).The CCI of the nystatin group were lower than those of the control group at T6 and T9 [T6∶0.19 ± 0.10 vs.0.39 ± 0.15,T9∶0.00 (0.10) vs.0.45 (0.30),all P＜0.05].The incidence of candidemia in the nystatin group was slightly lower than that in control group [0.5％ (3/60) vs.7.8％ (5/64),P＞0.05].The mortality in the nvstatin group was lower than that in control group [18.3％ (11/60) vs.34.4％ (22/64),P＜0.05].ICU day in the nystatin group was shorter than that in the control group (days ∶ 9.56 ± 3.47 vs.11.89 ± 6.32,P＜0.05).However,hospital day was similar in the two groups (days∶18.35 ±7.42 vs.20.58 ±8.77,P＞0.05).Conclusion Nystatin might reduce the colonization of Candida albicans and was associated with shorter ICU day.
