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目的研究重症肺部感染后患曲霉菌感染的危险因素、临床特征、影像学特点,以做到早期诊断和治疗。方法回顾分析2005年1月—2011年12月在呼吸重症监护室(RICU)的重症肺部感染继发曲霉菌感染患者,随机抽取同一时期未并发真菌感染的重症肺炎为对照组。记录患者临床资料,包括一般资料、基础疾病、治疗相关因素进行统计分析,以及血液指标、细菌培养结果和影像学资料。结果监护病房住院天数、广谱抗生素、糖皮质激素、机械通气(MV)、感染性休克、肝功能不全、糖尿病、免疫性疾病以及慢性呼吸道疾病(CRD)在2组比较中差异有统计学意义(P<0.05);而年龄、留置静脉导管、肠外营养以及实体肿瘤之间差异无统计学意义(P>0.05)。临床以发热、呼吸困难及肺部哮鸣音为主;外周血白细胞升高、CRP、IGE升高占较大比例;同时影像学具有不典型性,以肺纹理增重、片状渗出和实变等非特异性表现。抢救成功8例中7例为伏立康唑治疗。结论重症肺部感染后存在上述相关危险因素时需注意易患曲霉菌感染可能;由于其临床表现及影像学具有不典型性,因此临床医师应认识其好发因素、观察临床病情的变化、多次查痰培养,同时气管镜检查观察黏膜、PBS及活检获得病理不失为一个比较安全的方法,抢先治疗成为降低病死率的关键。
Objective To study the risk factors, clinical features and imaging features of Aspergillus infection after severe pulmonary infection in order to achieve early diagnosis and treatment. Methods A retrospective analysis of patients with severe aspergillosis infection of severe pulmonary infection in respiratory intensive care unit (RICU) from January 2005 to December 2011 was conducted. Randomly selected severe pneumonia without concurrent fungal infection in the same period as the control group. The clinical data of the patients were recorded, including general information, basic diseases, statistical analysis of treatment-related factors, blood parameters, bacterial culture results and imaging data. Results The length of stay in intensive care units, broad-spectrum antibiotics, glucocorticoids, mechanical ventilation (MV), septic shock, hepatic insufficiency, diabetes mellitus, autoimmune diseases and chronic respiratory disease (CRD) were significantly different between the two groups (P <0.05). There was no significant difference in age, indwelling venous catheters, parenteral nutrition and solid tumors (P> 0.05). Clinical fever, dyspnea and lung wheeze dominated; peripheral leukocytes, CRP, IGE increased accounted for a large proportion; the same time with atypical imaging, with lung weight gain, exudative and flake Consistency and other non-specific performance. Seven patients were successfully treated with voriconazole in eight patients. Conclusions In the presence of the above-mentioned risk factors associated with severe pulmonary infection, attention should be paid to the possibility of infection with aspergillosis. Because of its clinical manifestations and radiological findings, clinicians should recognize the risk factors and observe the clinical changes Secondary sputum culture, while bronchoscopy to observe the mucosa, PBS and biopsy access to pathological loss is a safer method, preemptive treatment as the key to reducing mortality.