CAJ | 학술논문

目的：分析急诊重症监护室（EICU）376例肺部真菌感染患者的危险（宿主）因素、临床特征、病原学分布及防治措施。方法2008年3月—2014年1月贵阳医学院附属医院EICU共收治患者2165例，其中肺部真菌感染376例，回顾性分析376例患者的临床资料，包括：危险（宿主）因素（包括基础疾病及合并症、常见易患因素）、临床特征、病原学分布、治疗及转归情况。结果 2165例患者中肺部真菌感染376例，院内获得性肺部真菌感染364例，占同期住院患者的16.81％；96.81％（364/376）的患者至少有一种基础疾病，其中60.63％有原发性肺部基础疾病，42.55％合并多器官功能障碍综合征。肺部真菌感染患者的易患因素主要有使用广谱抗生素（﹥1周）、高糖血症（葡萄糖﹥7.0 mmol/L）、侵入性诊疗操作、低蛋白血症及呼吸机辅助呼吸（﹥48 h）等。患者临床表现无特异性。376例肺部真菌感染患者共培养鉴定475株真菌，其中白色假丝酵母菌225株（占47.37％）、非白色假丝酵母菌250株（占52.63％）；35.11％（132/376）的患者为混合感染。治疗有效率为71.63％，相关病死率为28.37％。结论 EICU患者肺部真菌感染发生率较高，且该病是多种基础疾病及危险因素共同作用的结果，病原菌多为条件致病菌，非白色假丝酵母菌感染呈上升趋势，部分患者为混合感染；临床表现无特异性，且早诊断困难、预后差。
목적：분석급진중증감호실（EICU）376례폐부진균감염환자적위험（숙주）인소、림상특정、병원학분포급방치조시。방법2008년3월—2014년1월귀양의학원부속의원EICU공수치환자2165례，기중폐부진균감염376례，회고성분석376례환자적림상자료，포괄：위험（숙주）인소（포괄기출질병급합병증、상견역환인소）、림상특정、병원학분포、치료급전귀정황。결과 2165례환자중폐부진균감염376례，원내획득성폐부진균감염364례，점동기주원환자적16.81％；96.81％（364/376）적환자지소유일충기출질병，기중60.63％유원발성폐부기출질병，42.55％합병다기관공능장애종합정。폐부진균감염환자적역환인소주요유사용엄보항생소（﹥1주）、고당혈증（포도당﹥7.0 mmol/L）、침입성진료조작、저단백혈증급호흡궤보조호흡（﹥48 h）등。환자림상표현무특이성。376례폐부진균감염환자공배양감정475주진균，기중백색가사효모균225주（점47.37％）、비백색가사효모균250주（점52.63％）；35.11％（132/376）적환자위혼합감염。치료유효솔위71.63％，상관병사솔위28.37％。결론 EICU환자폐부진균감염발생솔교고，차해병시다충기출질병급위험인소공동작용적결과，병원균다위조건치병균，비백색가사효모균감염정상승추세，부분환자위혼합감염；림상표현무특이성，차조진단곤난、예후차。
Objective To explore the related factors ( host ), clinical feature, etiology, prevention and control measures of 376 patients with pulmonary fungal infection in emergency intensive care unit( EICU). Methods A total of 376 patients with pulmonary fungal infection were selected out of 2 165 patients admitted to Department of EICU, the Affiliated Hospital of Guiyang Medical College from March 2008 to January 2014,clinical data including related factors(host)(including underlying diseases, complications, common risk factors ), clinical feature, etiology, treatment and prognosis was retrospectively analyzed. Results In the 376 cases,364 cases were hospital-acquired,accounted for 16. 81% of all of the 2 165 cases. In the 376 cases,364 cases ( 96. 81%) existed at least 1 kind of underlying diseases, mainly were primary lung diseases(60. 63%),and the incidence of multiple organ dysfunction syndrome ( MODX ) was 42. 55%. The risk factors including using wide-spectrum antibiotics(over 1 week),hyperglycemia(blood glucose﹥7. 0 mmol/L),invasive diagnosis and treatment,hypoproteinemia and breathing machine ventilation( over 48 hours). The clinical feature was not specific. A total of 475 strains of fungus was separated out,including 225 strains(47. 37%)of Monilia Albicans,250 strains(52. 63%)of non Monilia Albicans,and 132 cases(35. 11%) were mixed infection. The effective rate was 71. 63%,and the mortality rate was 28. 37%. Conclusion Patients in EICU have higher incidence of pulmonary fungus infection, it is related to kinds of underlying diseases and multiple risk factors;the main etiology is opportunistic pathogen, but the proportion of non Monilia albicans is increasing,part of patients are mixed infection;the clinical feature is not specific,so it is hard to be diagnosed and treated,the prognosis is poor.