上海交通大学学报（医学版）

›› 2009, Vol. 29 ›› Issue (8): 975-.

• 论著（临床研究） • 上一篇    下一篇

急诊ICU机械通气患者下呼吸道真菌感染临床分析

王树云, 葛勤敏   

  1. 上海交通大学 医学院新华医院急救中心ICU, 上海 200092
  • 出版日期:2009-08-25 发布日期:2009-09-27
  • 作者简介:王树云（1961—）, 男, 主任医师, 学士；电子信箱: wangshuyun1665@163.com。

Clinical analysis of lower respiratory tract fungal infection in patients with mechanical ventilation in emergency intensive care unit

WANG Shu-yun, GE Qin-min   

  1. Department of EICU, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200092, China
  • Online:2009-08-25 Published:2009-09-27

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摘要：

目的 分析急诊重症加强治疗病房（EICU）机械通气患者下呼吸道真菌感染的临床特点、菌株分布和治疗转归。 方法 回顾性分析124例在EICU机械通气中发生下呼吸道真菌感染患者的临床资料。 结果 124例机械通气患者中80例（64.5%）出现下呼吸道感染，其中伴有真菌感染21例（26.2%），皆为假丝酵母菌（白假丝酵母菌11例、热带假丝酵母菌5例、光滑假丝酵母菌3例、近平滑假丝酵母菌2例）。真菌感染(n=21)与非真菌感染患者(n=59)比较，Apache Ⅱ评分较高，机械通气和住EICU时间较长，差异均有统计学意义（P<0.05）。11例白假丝酵母菌感染者无一例死亡，非白假丝酵母菌感染者死亡7例。 结论 EICU机械通气患者下呼吸道真菌感染发生率较高，主要是假丝酵母菌感染，以白假丝酵母菌为主。非白假丝酵母菌感染病死率高，对氟康唑耐药，提示应早期采取有效的干预措施。

关键词: 重症加强治疗病房, 机械通气, 真菌感染

Abstract:

Objective To investigate the clinical characteristics, pathogen distribution and outcome of lower respiratory tract fungal infection in patients with mechanical ventilation in emergency intensive care unit (EICU). Methods The clinical data of  patients with lower respiratory tract fungal infection treated with mechanical ventilation in EICU were retrospectively analysed. Results Eighty (64.5%) of the 124 patients with mechanical ventilation experienced lower respiratory tract infection, among whom 21(26.2%) were complicated with fungal infection. The predominant pathogen was Candida (Candida albicans, n=11; Candida tropicalis, n=5; Candida smooth, n=3; Candida parapsilosis, n=2). Compared with patients with non-fungal infection (n=59), those with fungal infection(n=21) had higher APACHE II score, longer mechanical ventilation time and longer ICU stay duration（P<0.05）. No death occurred in patients with Candida albicans infection, while 7 patients with non-Candida albicans infection died. Conclusion The prevalence of lower respiratory tract fungal infection is high in patients with mechanical ventilation hospitalized in EICU, and the major pathogens are Candida, with Candida albicans as the dominant one. The mortality of patients with non-Candida albicans infection is high, and is drugresistant to fluconazol, which indicates early and effective interventions should be taken.

Key words: intensive care unit, mechanical ventilation, fungal infection

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