医院深部真菌感染患儿死亡危险因素分析  

Risk factors related to mortality in children with nosocomial fungal deep infection

作　　者：曹清[1] 周云芳[1] 薛惠良[1] 汤静燕[1] 

机构地区：[1]上海交通大学医学院附属新华医院上海儿童医学中心,200127

出　　处：《中国小儿急救医学》2007年第3期206-208,共3页Chinese Pediatric Emergency Medicine

摘　　要：目的探讨导致深部真菌感染患儿死亡的危险因素，以利I临床医师提高对其认识，降低相关病死率。方法2000年1月～2005年12月住院患儿中确诊深部真菌感染41例，运用回顾性病例对照研究策略，以患儿入院日为研究起点，死亡或出院为终点。研究因素包括性别、原发病、感染部位、病原菌类型、并发症、治疗措施等16个变量。建立Logistic回归模型，计算校正前后的优势比（OR）及其95％可信区间（CI）。结果41例患儿中19例死亡，占46％。单因素分析显示，医院深部真菌感染患儿死亡因素包括相关粒细胞减少、合并细菌感染、感染性休克、肾功能损害、肝功能损害、心功能不全、胃肠功能不全、低蛋白血症、贫血、抗真菌治疗不及时和广谱抗生素应用。经逐步引入剔除法，建立Logistic回归模型，发现医院深部真菌感染死亡危险因素为：肾功能损害（OR=20.477，95％CI为1．111～377．381）、胃肠功能不全（OR=28．720，95％CI为2．282～361．465）和抗真菌治疗不及时（OR=9．953，95％CI为0．786～125．954）。结论在医院深部真菌感染患儿中，肾功能损害、胃肠功能不全和抗真菌治疗不及时是预后不良的危险因素。Objective To investigate risk factors related to mortality in children with nosocomial fungal deep infection. Methods A retrospective case-control study was applied. All 41 patients with diagnosis of nosocomial fungal deep infection from January 2000 to December 2005 in our hospital were included. There were 16 variables such as sex, primary disease, infectious site, complication, pathogenic type and therapeutic measures were set as research factors. The data were analyzed with the logistic regression model. Results Of 41 patients, 19 died （46.34 % ）. Variables in the univariate analysis that were significantly associated with death from nosocomial fungal deep infection were granulocytopenia, concurrent bacterial infection, septic shock, renal dysfunction, hepatic dysfunction, cardiac insufficiency, gastrointestinal tract functional defect, hypoproteinemia, anemia, inappropriate antifungal and broad-spectrum antibiotic usage. In the logistic regression model, the variables significantly associated with mortality were renal dysfunction （OR = 20. 477, 95 % CI： 1.111 - 377. 381 ）, gastsointestinal tract functional defect （OR = 28. 720, 95 % CI： 2. 282 - 361. 465 ） and inappropriate antibiotic usage （OR = 9. 953, 95 % CI： 0. 786 - 125. 954 ）. Conclusion Renal dysfunction, gastrointestinal tract functional defect and inappropriate antibiotic usage are the risk factors related to mortality in children with nosocomial fungal deep infection.

关 键 词：医院深部真菌感染 白色念珠菌 预后 

分 类 号：R72[医药卫生—儿科]