论文部分内容阅读
目的:探讨我院呼吸内科病房老年肺部疾病患者并发真菌感染发病的相关因素,分析其易患因素、临床特征和治疗。方法:采用回顾性调查方法对2002年1月至2008年6月收住内科的经微生物检查证实49例继发真菌感染的患者进行分析,并与同期无真菌感染的肺部疾病患者(对照组)比较。结果:在呼吸内科病房中,老年患者院内肺部真菌感染发生率为3.78%,主要感染部位为泌尿系(21.8%),呼吸道(26.9%),消化道(40.9%)。慢性阻塞性肺疾病(49.8%)是继发院内肺部真菌感染最常见的基础疾病,其感染因素为长期使用广谱抗生素(96.2%)和糖皮质激素(33.2%)、营养状况不良(58.3%)出现低蛋白血症及合并糖尿病、白细胞减少和侵袭性诊疗操作等。肺部真菌感染的临床表现无特异性,确诊需结合痰培养,组织病理学和临床表现来确定,感染菌种以白色念珠菌为主,占62.6%。氟康唑治疗有效率91.4%。研究组与同期无真菌感染的肺部疾病患者(对照组)比较:病死率分别为6.12%和0.82%,两组治疗无效的病例(恶化和死亡病例)比较差异有显著性。结论:院内真菌是呼吸系统疾病继发感染的重要病原体,而白色假丝酵母菌是院内肺部真菌感染的主要致病菌,宿主免疫状态、感染播散和疾病严重程度是影响预后的因素。该研究认为老年肺部疾病患者并发真菌感染的相关因素和影响预后的因素对其预防、诊断、治疗、改进预后和生存质量有重要的临床意义。除有效的抗真菌治疗外,积极的综合治疗有助于提高真菌感染的治愈率。
Objective: To explore the related factors of the onset of fungal infection in elderly patients with lung diseases in respiratory wards of our hospital and analyze their predisposing factors, clinical features and treatment. Methods: A retrospective survey was performed on 49 patients with confirmed secondary fungal infections confirmed by microbiological examination from January 2002 to June 2008 in our medical department. Patients with lung diseases without fungal infection (control group ) Comparison. Results: In the respiratory medical ward, the incidence of pulmonary fungal infection in elderly patients was 3.78%. The main infection sites were urinary tract (21.8%), respiratory tract (26.9%) and gastrointestinal tract (40.9%). Chronic obstructive pulmonary disease (49.8%) is the most common underlying cause of secondary pulmonary fungal infection in secondary hospital, with long-term use of broad-spectrum antibiotics (96.2%) and glucocorticoids (33.2%) and poor nutritional status (58.3 %) Appear hypoproteinemia and diabetes, leukopenia and invasive diagnosis and treatment operations. The clinical manifestations of pulmonary fungal infection is nonspecific. The diagnosis should be confirmed by sputum culture, histopathology and clinical manifestations. Candida albicans is the main infectious species, accounting for 62.6%. Fluconazole treatment was effective 91.4%. The study group and the same period of non-fungal infection of lung disease patients (control group) comparison: the mortality rate was 6.12% and 0.82%, two cases of ineffective treatment (deterioration and deaths) were significantly different. CONCLUSION: Nosocomial fungus is an important pathogen of secondary respiratory infections. Candida albicans is the main pathogen of pulmonary fungal infection in the hospital. The host immune status, the spread of infection and the severity of disease are the prognostic factors. The study concluded that factors associated with fungal infection and prognosis in elderly patients with pulmonary disease have important clinical implications for their prevention, diagnosis, treatment, improvement of prognosis and quality of life. In addition to effective antifungal therapy, aggressive combination therapy can help increase the cure rate for fungal infections.