颈椎骨折术后患者深部真菌感染原因分析与临床治疗  

Causes of postoperative deep fungal infections in cervical spine fracture patients and clinical treatment

作　　者：王述华[1] 邓经德 刘素珍[1] 张甜[1] 刘立斌[1] 

机构地区：[1]江西省兴国县人民医院骨科,江西兴国县342400

出　　处：《中华医院感染学杂志》2014年第14期3567-3568,3571,共3页Chinese Journal of Nosocomiology

基　　金：江西省卫生厅规划基金项目(JW-2009B-1099)

摘　　要：目的颈椎骨折术后患者深部真菌感染原因分析及临床治疗方法探讨,以期提高临床对颈椎骨折术后患者深部真菌感染的认识,从而提高治疗水平。方法选取2009年3月-2012年3月收治的颈椎骨折手术患者出现深部真菌感染121例,设为感染组,另选取同期行颈椎骨折术未感染患者111例,设为非感染组,比较两组患者临床资料,分析颈椎骨折术后患者发生深部真菌感染的原因并探讨临床治疗方法,采用SPSS统计软件对所有数据进行分析。结果导致颈椎骨折患者手术治疗后出现深部真菌感染的原因主要为年龄>60岁、留置尿管、深静脉置管、留置胃管、采用激素治疗等,与非感染组患者对比,差异有统计学意义;感染真菌最多的是白色假丝酵母菌有78株,其次是热带假丝酵母菌27株,感染送检标本最多的是痰液79例,其次是粪便25例;治疗有效率伏立康唑为83.3%、伊曲康唑为78.6%、氟康唑为57.1%、两性霉素B为46.2%,伏立康唑和伊曲康唑与氟康唑和两性霉素B对比,差异均有统计学意义。结论了解导致颈椎骨折患者手术治疗后发生深部真菌感染的原因并且积极采取有效的预防措施,对于出现感染的患者应该予以积极的抗真菌治疗。OBJECTIVE To explore the causes of postoperative deep fungal infections in cervical spine fracture patients and study the clinical treatment so as to improve the awareness of the clinicians about the deep fungal infections and raise the level of clinical treatment.METHODS A total of 121patients with deep fungal infections who underwent the cervical spine fracture surgery from Mar 2009to Mar 2012were assigned as the infection group,meanwhile,111cervical spine fracture patients without infections were set as the non-infection group,then the clinical data were compared between the two groups,the causes of the postoperative deep fungal infections were analyzed,the clinical treatment measures were explored,and all the data were statistically analyzed with the use of SPSS software.RESULTS The major causes of the postoperative deep fungal infections in the cervical spine fracture patients included the more than 60years of age,urinary catheter indwelling,gastric catheter indwelling,and use of hormone,as compared with the non-infection group,the differences were significant.Of the fungi causing the infections,there were 78strains of Candida albicans and 27strains of Candida tropicalis;79strains were isolated from sputum,25strains from feces.The effective rate of treatment of voriconazole was 83.3%,itraconazole78.6%,fluconazole 57.1%,amphotericin B 46.2%;the difference in the effective rate of treatment between voriconazole,itraconazole and fluoconazole,amphotericin was significant.CONCLUSIONIt is necessary to understand the causes of the postoperative deep fungal infections in the cervical spine fracture patients,take effective prevention measures,and conduct active antifungal therapy for the patients with infections.

关 键 词：颈椎骨折 深部真菌感染 原因分析 临床治疗 

分 类 号：R619.3[医药卫生—外科学]