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目的探讨ICU重症患者深部真菌感染的临床表现特征,寻求危重患者深部真菌感染的早期诊断方法。方法对2006年4月-2008年4月ICU收治存在真菌感染危险因素,并通过病原学确诊为深部真菌感染的73例重症患者的临床资料进行回顾性分析和研究。结果被确诊为深部真菌感染的73例ICU重症患者均存在真菌感染危险因素。在没有获得病原学证据的早期,出现用基础疾病难以解释的临床表现,其中:①发热、非抗真菌治疗无效68例(93.1%);②精神症状或突然意识障碍19例(26.0%);③多部位黏膜出血23例(31.5%);④重要脏器(称之为靶器官)损害37例(50.7%),并拟诊为真菌感染,同时给予积极的抗真菌治疗,使真菌感染在发病的早期得到了有效的控制。结论存在真菌感染的危险因素的ICU重症患者,出现下列一种以上不明原因的临床表现的:①发热、非抗真菌治疗无效;②突然的意识障碍或精神症状;③多部位黏膜出血;④重要脏器损害,在没有获得病原学证据的早期,临床上应拟诊为真菌感染,对临床危重患者的救治实践有着重要的指导意义。
Objective To investigate the clinical features of deep fungal infections in critically ill patients with ICU and seek early diagnosis of deep fungal infections in critically ill patients. Methods From April 2006 to April 2008, the clinical data of 73 patients with severe fungal infection confirmed by etiological diagnosis of ICU in our hospital were analyzed retrospectively. Results The 73 ICU critically ill patients diagnosed with deep fungal infection had risk factors for fungal infection. There were 68 cases (93.1%) with fever and non-antifungal therapy ineffective; (2) 19 cases (26.0%) of psychiatric symptoms or sudden disturbance of consciousness were found; in the early stage without etiological evidence, clinical manifestations were difficult to explain with underlying diseases. Multiple mucosal hemorrhage in 23 cases (31.5%); ④ important organs (called the target organ) damage in 37 cases (50.7%), and to be diagnosed as fungal infections, while giving positive antifungal therapy, fungal infections in Early onset of effective control. Conclusions ICU critically ill patients with risk factors for fungal infection have one or more of the following unexplained clinical manifestations: fever, non-antifungal therapy is ineffective; sudden disturbance of consciousness or psychiatric symptoms; mucosal hemorrhage at multiple sites; Organ damage, in the absence of early evidence of etiology, should be clinically diagnosed as fungal infections, clinical critically ill patients with the practice of treatment has an important guiding significance.