呼吸机相关性肺炎继发肺真菌感染的危险因素分析  

Risk factors analysis of secondary pulmonary fungal infections related to ventilator associated pneumonia

作　　者：黄玉晖[1] 谭辉[1] 朱大庆[1] 李炽观[1] 何炳文[1] 

机构地区：[1]湖南省郴州市第一人民医院呼吸内科,郴州423000

出　　处：《重庆医科大学学报》2011年第12期1488-1491,共4页Journal of Chongqing Medical University

摘　　要：目的:探讨呼吸机相关性肺炎(Ventilator associated pneumonia,VAP)继发真菌感染的有关危险因素,为临床早期诊断及治疗提供参考依据。方法:回顾性收集本院呼吸内科2005年6月-2010年6月期间经临床确诊为VAP的126例患者的临床资料,根据是否继发肺真菌感染分为真菌感染组(56例)和非真菌感染组(70例),分别对性别、年龄、合并基础疾病、血糖、低蛋白血症、气管切开、深静脉置管、机械通气时间、放疗或化疗、抗生素使用时间、联合应用抗生素、激素(或免疫抑制剂)、APACHEⅡ评分等13项危险因素进行单因素分析,并对显著相关性危险因素进行Logistic回归分析。结果:单因素分析显示年龄、合并基础疾病、血糖、低蛋白血症、机械通气时间、放疗或化疗、抗生素使用时间、联合应用抗生素、激素(或免疫抑制剂)、APACHEⅡ评分呈显著相关性;Logistic回归分析提示年龄、血糖、机械通气时间、放疗或化疗、抗生素使用时间、联合应用抗生素、激素(或免疫抑制剂)、APACHEⅡ评分与继发肺部真菌感染呈显著相关性。结论:VAP真菌感染受多种因素影响,临床治疗时应具体分析,对于高龄、机械通气时间长、血糖控制差、联合使用抗生素及时间长、激素(或免疫抑制剂)、APACHEⅡ评分等提示存在继发真菌敏感危险因素的,应重视这些危险因素的预测价值。Objective：To explore the risk factors for secondary pulmonary fungal infections related to ventilator associated pneumonia（VAP） in order to provide the reference for clinical diagnosis and treatment.Methods：The clinical data of 126 patients with pulmonary fungal infections related to VAP from June 2005 to June 2010 were retrospectively collected.The patients were divided into fungal infection group（56 patients） and non-fungal infection group（70 patients）.The risk factors including gender,age,complicated basic diseases,blood sugar,hypoalbuminemia,trachea incision,deep venipuncture,mechanical ventilation time,radiation or chemotherapy,time of using antibiotics,combined use of antibiotics,glucocorticosteroid（immunodepressant）,and APACHEⅡscore were analyzed using the single factor analysis and logistic regression.Results：The single factor analysis showed that age,complicated basic diseases,blood sugar,hypoalbuminemia,mechanical ventilation time,radiation and chemotherapy,time of using antibiotics,combined use of antibiotics,glucocorticosteroid（immunodepressant）,and APACHEⅡscore were significantly correlated.Logistic regression analysis suggested blood sugar,mechanical ventilation time,time of using antibiotics,combined use of antibiotics,glucocorticosteroid（immunodepressant）,and APACHEⅡscore were significantly correlated.Conclusion：Multiple factors affect pulmonary fungus infection,and clinical treatment should be specificly analysed as to the risk factors of older age,mechanical ventilation time,blood sugar,time of using antibiotics,combined of antibiotics,glucocorticosteroid（immunodepressant）,and high APACHEⅡscore.

关 键 词：呼吸机相关性肺炎 真菌感染 危险因素 

分 类 号：R563.1[医药卫生—呼吸系统]