ICU慢性阻塞性肺疾病患者并发真菌感染的危险因素探讨(1)
【摘要】 目的：探究ICU慢性阻塞性肺疾病(chronic obstructive pulmonary disease，COPD)患者并发真菌感染的危险因素及探讨防治策略。方法：回顾性分析2018年3月-2019年3月本院ICU收治的217例COPD患者的临床资料，按照是否并发真菌感染分为真菌感染组(n=48)和未并发真菌感染组(n=169)。分析ICU COPD患者并发真菌感染的独立危险因素。结果：两组性别、年龄、BMI、COPD分级及是否合并高血压及右心衰竭比较，差异均无统计学意义(P>0.05);两组是否合并高血糖、抗菌药物使用时间及是否合并使用糖皮质激素比较，差异均有统计学意义(P<0.05)。合并糖尿病、抗菌药物使用时间≥10 d及合并使用糖皮质激素为ICU COPD患者并发真菌感染的独立危险因素(P<0.05)。结论：合并糖尿病、长期使用抗菌药物及合并使用糖皮质激素为ICU COPD患者并发真菌感染的独立危险因素。严格控制COPD患者基础疾病，减少并控制广谱抗菌类和糖皮质激素类药物的使用和疗程，可降低真菌感染的发生。
【关键词】 慢性阻塞性肺疾病 真菌感染
[Abstract] Objective： To explore the risk factors of complicated fungal infection in ICU patients with chronic obstructive pulmonary disease (COPD). Method： The clinical data of 217 patients with COPD admitted to the ICU of our hospital from March 2018 to March 2019 were retrospectively analyzed. They were divided into the fungal infection group (n=48) and the non-fungal infection group (n=169) according to whether complicated fungal infection. The independent risk factors of complicated fungal infection in ICU patients with COPD were analyzed. Result： There were no statistically significant differences between the two groups in gender， age， BMI， COPD grading and whether complicated hypertension and right heart failure (P>0.05). Whether complicated hyperglycemia， duration of antibiotic use and whether use glucocorticoid between the two groups were compared， the differences were statistically significant (P<0.05). Diabetes mellitus， antibiotic use time ≥10 d and combined use of glucocorticoids were independent risk factors for complicated with fungal infection in ICU patients with COPD (P<0.05). Conclusion： Diabetes mellitus， long-term use of antibiotics and glucocorticoids were independent risk factors for complicated with fungal infection in ICU patients with COPD. Strict control of basic diseases in patients with COPD， reduce and control the use and treatment of broad-spectrum antibacterial and glucocorticoid drugs， can reduce the incidence of fungal infection.
[Key words] Chronic obstructive pulmonary disease Fungal infection
First-author’s address： Laixi People’s Hospital， Laixi 266600， China
doi：10.3969/j.issn.1674-4985.2020.16.016
慢性阻塞性肺疾病(chronic obstructive pulmonary disease，COPD)是以呼吸道氣流受限为主要特征的一种常见呼吸系统疾病。呼吸道细菌或病毒感染是COPD急性发作最常见诱因，其中细菌性感染可高达50%[1-2]。因此，临床中对COPD的治疗不仅需要常规使用糖皮质激素类药物，联合使用抗菌药物进行抗感染治疗亦是目前治疗COPD的重要组成部分之一[3-4]。近年来，随着我国社会老龄化逐渐加重，由于老年患者免疫功能低下，除COPD外，常合并多种基础疾病，尤其是ICU患者在临床中普遍接受广谱抗菌药物及糖皮质激素治疗，导致机会性真菌感染的发生率逐渐增多。流行病学调查显示，在ICU住院一周以上的患者中50%～60%存在白色念珠菌定植[5]。COPD患者在治疗过程中发生院内机会性真菌感染将严重影响患者预后及转归，并进一步延长患者住院时间，增加患者住院费用[6-7]。因此，寻找COPD患者并发机会性真菌感染的相关影响因素对于机会性真菌感染的预防和治疗至关重要，本研究对2018年3月-2019年3月本院ICU收治的COPD患者217例的临床资料进行回顾性分析，探讨COPD患者并发真菌感染的危险因素及防治策略，旨在为机会性真菌感染的预防和治疗提供客观依据，以提高COPD患者的预后，减少患者住院费用和住院时间，现报道如下。, http://www.100md.com(刘瑞云)
【关键词】 慢性阻塞性肺疾病 真菌感染
[Abstract] Objective： To explore the risk factors of complicated fungal infection in ICU patients with chronic obstructive pulmonary disease (COPD). Method： The clinical data of 217 patients with COPD admitted to the ICU of our hospital from March 2018 to March 2019 were retrospectively analyzed. They were divided into the fungal infection group (n=48) and the non-fungal infection group (n=169) according to whether complicated fungal infection. The independent risk factors of complicated fungal infection in ICU patients with COPD were analyzed. Result： There were no statistically significant differences between the two groups in gender， age， BMI， COPD grading and whether complicated hypertension and right heart failure (P>0.05). Whether complicated hyperglycemia， duration of antibiotic use and whether use glucocorticoid between the two groups were compared， the differences were statistically significant (P<0.05). Diabetes mellitus， antibiotic use time ≥10 d and combined use of glucocorticoids were independent risk factors for complicated with fungal infection in ICU patients with COPD (P<0.05). Conclusion： Diabetes mellitus， long-term use of antibiotics and glucocorticoids were independent risk factors for complicated with fungal infection in ICU patients with COPD. Strict control of basic diseases in patients with COPD， reduce and control the use and treatment of broad-spectrum antibacterial and glucocorticoid drugs， can reduce the incidence of fungal infection.
[Key words] Chronic obstructive pulmonary disease Fungal infection
First-author’s address： Laixi People’s Hospital， Laixi 266600， China
doi：10.3969/j.issn.1674-4985.2020.16.016
慢性阻塞性肺疾病(chronic obstructive pulmonary disease，COPD)是以呼吸道氣流受限为主要特征的一种常见呼吸系统疾病。呼吸道细菌或病毒感染是COPD急性发作最常见诱因，其中细菌性感染可高达50%[1-2]。因此，临床中对COPD的治疗不仅需要常规使用糖皮质激素类药物，联合使用抗菌药物进行抗感染治疗亦是目前治疗COPD的重要组成部分之一[3-4]。近年来，随着我国社会老龄化逐渐加重，由于老年患者免疫功能低下，除COPD外，常合并多种基础疾病，尤其是ICU患者在临床中普遍接受广谱抗菌药物及糖皮质激素治疗，导致机会性真菌感染的发生率逐渐增多。流行病学调查显示，在ICU住院一周以上的患者中50%～60%存在白色念珠菌定植[5]。COPD患者在治疗过程中发生院内机会性真菌感染将严重影响患者预后及转归，并进一步延长患者住院时间，增加患者住院费用[6-7]。因此，寻找COPD患者并发机会性真菌感染的相关影响因素对于机会性真菌感染的预防和治疗至关重要，本研究对2018年3月-2019年3月本院ICU收治的COPD患者217例的临床资料进行回顾性分析，探讨COPD患者并发真菌感染的危险因素及防治策略，旨在为机会性真菌感染的预防和治疗提供客观依据，以提高COPD患者的预后，减少患者住院费用和住院时间，现报道如下。, http://www.100md.com(刘瑞云)
参见：首页 > 医疗版 > 疾病专题 > 中医疾病