急诊ICU 226例患者肺部真菌感染危险因素及防护策略研究  

Risk factors and preventive strategies of pulmonary fungal infection in 226 patients with emergency ICU

作　　者：鲁秦阳 刘善收 罗恒 艾美梅 LU Qin-yang;LIU Shan-shou;LUO Heng;AI Mei-mei(Department of Emergency,the First Affiliated Hospital of Air Force Medical University,Xi'an 710032,China)

机构地区：[1]空军军医大学第一附属医院急诊科,陕西西安710032 [2]空军军医大学第一附属医院外科,陕西西安710032

出　　处：《创伤与急危重病医学》2024年第2期70-73,83,共5页Trauma and Critical Care Medicine

基　　金：陕西省自然科学基础研究计划项目(2020JQ-466)。

摘　　要：目的探讨急诊ICU226例患者肺部真菌感染的危险因素及预防策略研究。方法纳入空军军医大学第一附属医院急诊ICU自2021年3月至2023年6月治疗的226例患者,其中,111例存在肺部真菌感染(感染组),115例为非肺部真菌感染(非感染组)。收集患者临床资料,采用Logistics回归模型分析危险因素,经回归方程拟合的概率值绘制受试者工作特征(ROC)曲线。结果111例肺部真菌感染患者中,共检出123株真菌,其中,93株为白假丝酵母,占比高达75.61%。多因素Logistic回归显示:糖尿病、广谱抗菌药物使用时间、广谱抗菌药物种类、糖皮质激素使用时间、机械通气、血红蛋白(Hb)、血清白蛋白(ALB)是急诊ICU患者肺部真菌感染的重要影响因素(P<0.05)。ROC分析显示:联合预测评估肺部真菌感染情况的ROC曲线下面积为=0.992(95%可信区间为0.983~1.000,P<0.05),敏感度为0.973,特异度为0.948。结论白假丝酵母为急诊ICU肺部真菌感染常见菌株。糖尿病、广谱抗菌药物使用时间、广谱抗菌药物种类、糖皮质激素使用时间、机械通气、Hb、ALB是急诊ICU患者肺部真菌感染的重要影响因素。Objective To investigate the risk factors and prevention strategies of pulmonary fungal infection in 226 patients with emergency ICU.Methods Among 226 patients treated in the Emergency ICU of the First Affiliated Hospital of Air Force Military Medical University from March 2021 to June 2023,111 patients had pulmonary fungal infection and 115 patients had non-pulmonary fungal infection.The clinical data of the two groups were collected,the risk factors were analyzed by logistics regression model,and the ROC curve was drawn by the probability value fitted by the regression equation.Results In 111 patients with pulmonary fungal infection,123 strains of fungi were detected,of which 93 strains were Candida alba,accounting for 75.61%.Multivariate Logistic regression showed that diabetes mellitus,duration of use of broad-spectrum antibiotics,types of broad-spectrum antibiotics,duration of glucocorticoid use,mechanical ventilation,hemoglobin(Hb)and serum albumin(ALB)were important influencing factors of pulmonary fungal infection in emergency ICU patients(P<0.05).ROC analysis showed that the AUC of combined prediction and evaluation of pulmonary fungal infection was 0.992,95%credibility interval was 0.983~1.000(P<0.05),sensitivity was 0.973,specificity was 0.948.Conclusion Candida alba is a common strain of pulmonary fungal infection in emergency ICU.Diabetes mellitus,duration of use of broad-spectrum antimicrobials,types of broad-spectrum antimicrobials,duration of use of glucocorticoids,mechanical ventilation,Hb,ALB were important factors affecting pulmonary fungal infection in emergency ICU patients.

关 键 词：急诊重症监护室 真菌感染 真菌分布 相关因素 预测模型 防护策略 

分 类 号：R816.8[医药卫生—放射医学]