Li Ming, Chen Zhuang-gui, Zhang Chang-ran, Lin Jian-cong, Zeng Mian
Department of Respiratory Diseases, Huangpu Branch of the First Hospital Affiliated to Sun Yat-sen University, Guangzhou 510080, China.
Nan Fang Yi Ke Da Xue Xue Bao. 2008 Mar;28(3):463-6.
To investigate the risk factors of pulmonary fungal infections related to mechanical ventilation and the prognosis of patients.
A retrospective case-controlled study was conducted to analyze the culture results of the pulmonary secretions in patients with pulmonary fungal and nonfungal infections in association with mechanical ventilations. The risk factors of pulmonary fungal infections related to mechanical ventilation were identified and their impact on the clinical outcome of the patients was evaluated.
Of the 127 patients included in this study, 81 (63.78%) were positive and 46 (36.22%) negative for pulmonary fungal infections according to the diagnostic criteria of ventilator-associated pneumonia (VAP). The mortality of the patients with fungal infection was 82.7%, significantly higher than that of patients with non-fungal infection (67.39%, chi2=3.910, P<0.05). Univariate analysis and multivariate logistic regression showed that such factors as old age, duration of mechanical ventilation, tracheal intubation or incision for over 7 days, diabetes, blood glucose over 6.1 mmol/L, multi-organ dysfunction, combined use of antibiotics, at least 3-time changes antibiotics, administration of glucocorticosteroid for over 7 days, and immunodepressant use were all the independence risk factors of pulmonary fungal infection related to mechanical ventilation. Old age, multi-organ dysfunction, blood glucose over 6.1 mmol/L, glucocorticosteroid use for over 7 days, anesthetic use for over 3 days and high APACHE III scores were the risk factors for mortality in patients with the infections.
Pulmonary fungal infection associated to mechanical ventilation is often the results of presence of multiple risk factors, and early identification of these factors for timely antifungal treatment may improve the prognostics of the patients and help reduce the mortality rate.
探讨与机械通气相关的肺部真菌感染的危险因素及患者的预后情况。
进行一项回顾性病例对照研究，分析肺部真菌感染患者和非真菌感染患者在机械通气情况下的肺分泌物培养结果。确定与机械通气相关的肺部真菌感染的危险因素，并评估其对患者临床结局的影响。
根据呼吸机相关性肺炎（VAP）的诊断标准，本研究纳入的127例患者中，81例（63.78%）肺部真菌感染呈阳性，46例（36.22%）呈阴性。真菌感染患者的死亡率为82.7%，显著高于非真菌感染患者（67.39%，χ2 = 3.910，P < 0.05）。单因素分析和多因素logistic回归显示，年龄较大、机械通气时间、气管插管或切开超过7天、糖尿病、血糖超过6.1 mmol/L、多器官功能障碍、联合使用抗生素、至少3次更换抗生素、使用糖皮质激素超过7天以及使用免疫抑制剂均为与机械通气相关的肺部真菌感染独立危险因素。年龄较大、多器官功能障碍、血糖超过6.1 mmol/L、使用糖皮质激素超过7天、使用麻醉剂超过3天以及较高的APACHE III评分是感染患者死亡的危险因素。
与机械通气相关的肺部真菌感染往往是多种危险因素共同作用的结果，早期识别这些因素并及时进行抗真菌治疗可能改善患者预后，降低死亡率。
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