重症监护病房呼吸机相关真菌肺炎的临床调查与分析  

Clinical survey and analysis of ventilator associated fungal pneumonia in intensive care unit

作　　者：骆雪萍[1] 施善阳[1] 黄巍[1] 

机构地区：[1]广西桂林医学院附属医院ICU,541001

出　　处：《重庆医学》2009年第23期2968-2970,共3页Chongqing medicine

基　　金：广西卫生厅自然科学基金资助项目(Z2005167)

摘　　要：目的调查重症监护病房(ICU)呼吸机相关真菌肺炎(VAFP)的临床特征。方法回顾性调查2006年1月至2007年12月VAFP病原菌分布、耐药等情况,与同期呼吸机相关非真菌肺炎(VANFP)组比较年龄、SAPSⅡ评分、机械通气(MV)时间及病死率。结果VAFP占呼吸机相关肺炎(VAP)33.64%(36/107),其年龄、SAPSⅡ评分及病死率较VANFP组差异有统计学意义(P<0.05)。病原菌分布白色假丝酵母菌占55.56%(20/36),光滑假丝酵母菌占22.22%(8/36),热带假丝酵母菌占13.89%(5/36)。非白色假丝酵母菌对氟康唑敏感率53.33%(8/15)。结论VAFP是ICU院内感染的主要来源之一,其发生与年龄、疾病的严重程度相关,预后极差。应合理选择抗真菌药物,避免合并多重耐药细菌感染。Objective To investigate the characteristics of ventilator associated fungal pneumonia （VAFP） in ICU. Methods The clinical data of patients with VAFP between January 2006 and December 2007 were retrospectively analyzed,including fungal species distribution,drug resistance,etc. The patients with VAFP were compared with those with ventilator associated non-fungal pneumonia （VANFP） in ages,SAPS Ⅱ,duration of mechanical ventilation（MV） and mortality. Results VAFP occurred in 36 cases,accounting for 33.64% of all 107 patients with VAP. The differences in ages,SAPS Ⅱ and mortality between the two groups of the patients with VAFP and VANFP were significant （P〈0.05）. The VAFP fungal species distribution was as follows：Candida albicans accounted for 55.56%（20/36） ,Candida glabrata 22.22% （8/36） ,Candida tropicalis 13.89%（5/36）. The susceptibility rates of non-albieans Candida to fluconazole was 53.33 % （8/15）. Conclusion VAFP is one of the main sources of nosocomial infections in ICU. VAFP is related to the age of patients and severity of the diseases and the prognosis of VAFP is very poor. It would be strengthened to use antifungal drugs reasonably and avoid the infection of multidrug-resistant bacteria.

关 键 词：呼吸机相关真菌肺炎 病原菌 非白色假丝酵母菌 耐药 

分 类 号：R446.5[医药卫生—诊断学]