机械通气患者下呼吸道念珠菌去定植治疗对预后的影响  

Impact of antifungal therapy in mechanically ventilated patients with Candida spp. colonization in lower respiratory tract

作　　者：张舸[1] 冯彬彬[1] 陆志华[1] 苏伟[1] 吴银山 

机构地区：[1]浙江大学医学院附属邵逸夫医院重症医学科,杭州310016

出　　处：《中华医学杂志》2017年第28期2198-2201,共4页National Medical Journal of China

基　　金：浙江省教育厅项目（Y201431551）

摘　　要：目的 观察机械通气患者下呼吸道念珠菌去定植治疗对预后的影响。方法 回顾性分析2012年7月至2016年6月期间，入住浙江大学医学院附属邵逸夫医院重症监护病房（ICU）的下呼吸道分泌物培养到念珠菌的危重机械通气患者，分为抗真菌治疗组和未进行抗真菌治疗的对照组。观察两组患者呼吸道多重耐药菌（MDR）的分离率、呼吸机相关性肺炎（VAP）的发生率、机械通气时间、入住ICU时间、总住院时间、28 d死亡率和总死亡率的区别。结果 共有101例患者纳入研究，其中抗真菌治疗组56例，对照组45例。抗真菌治疗组MDR细菌的分离率为16.1%，小于对照组（33.3%），差异有统计学意义（P〈0.05）；抗真菌治疗组的VAP发生率5.4%，小于对照组（17.8%），差异有统计学意义（P〈0.05）；抗真菌治疗组机械通气时间是（17.3±5.7）d，短于对照组的（22.5±7.2）d，抗真菌治疗组平均入住ICU的时间是（23.3±5.6）d，总平均住院时间是（36.2±8.7）d，均短于对照组的（28.7±4.8）d和（43.6±9.0）d,差异有统计学意义（P〈0.05）。两组的28 d死亡率和总死亡率间的差异无统计学意义。结论 对下呼吸道分泌物培养到念珠菌的危重机械通气患者进行抗真菌治疗，可以减少MDR细菌的分离率和VAP的发生率，并缩短机械通气时间、入住ICU时间和总住院时间。Objective To explore the impact of antifungal therapy in mechanically ventilated patients with Candida spp. colonization in lower respiratory tract.Methods In this retrospective study, patients required mechanical ventilation with pulmonary Candida spp. colonization admitted into the intensive care unit （ICU） between July 2012 and June 2016 were included. The patients were divided into the treatment group and control group according to whether or not they received antifungal therapy. The isolation rate of multidrug-resistant （MDR） bacteria, the incidence of ventilator-associated pneumonia （VAP）, duration of mechanical ventilation, length of ICU stay, total length of hospital stay, the 28-day mortality and the overall mortality were compared between the two groups.Results Totally, 101 patients were studied. The number of cases in treatment group was 56 and the control group was 45. The treatment group had a lower incidence of MDR bacteria isolation rate and VAP compared with the control group （16.1% vs 33.3%, 5.4% vs 17.8% respectively, both P〈0.05）. There were significant differences in the duration of mechanical ventilation [（17.3±5.7） days vs （22.5±7.2） days, P〈0.05], length of ICU stay [（23.3±5.6） days vs （28.7 ±4.8） days, P〈0.05] and the average length of hospital stay [（36.2±8.7） days vs （43.6±9.0） days, P〈0.05）] in the treatment group compared with the control group. There were no statistical difference between the two groups in the 28-day mortality and the overall mortality.Conclusion Treatment of respiratory Candida spp. colonization in mechanically ventilated patients may reduce isolation rate of MDR bacteria, the incidence of VAP, duration of mechanical ventilation, length of ICU stay and total length of hospital stay.

关 键 词：抗真菌治疗 念珠菌 呼吸道 机械通气 预后 

分 类 号：R459.7[医药卫生—急诊医学]