老年慢性阻塞性肺疾病患者院内肺部真菌感染临床分析

目的探讨老年慢性阻塞性肺疾病（COPD）患者院内肺部真菌感染的可能易患因素、感染时间、临床特征、感染常见真菌与预后。方法回顾性分析36例65岁以上COPD院内肺部真菌感染患者与同期40例65岁以上COPD院内肺部非真菌感染患者的临床资料。结果老年COPD患者院内肺部真菌感染的可能易患因素与长期使用广谱抗生素、糖皮质激素,低蛋白血症、粒细胞减少相关;吸烟时间较长及每年住院次数增多也是老年COPD患者发生院内肺部真菌感染的可能易感因素;约1/3患者肺部真菌发生在入院1～2周,临床特征无特异性;病原菌主要为白色念珠菌（80.55%）,胸部X线表现以支气管肺炎及团块影改变为主,预后较差。结论老年COPD患者若长期使用广谱抗生素和（或）糖皮质激素,有低蛋白血症或粒细胞减少,可能会并发院内肺部真菌感染,预后较差,长期吸烟及多次住院患者也应提高警惕,重视可能易患因素并尽早采取预防与治疗措施,减少死亡的发生。

Clinical Analysis of Elderly Patients with Chronic Obstructive Pulmonary Disease with Nosocomial Pulmonary Fungal Infection

Objective To investigate the possible risk factors of nosocomial pulmonary fungal infection,infection time,the clinical features,common infection fungal and prognosis of elderly patients with chronic obstructive pulmonary disease（COPD）.Methods The clinical data of 36 patient of COPD complicated with nosocomial pulmonary fungal infection over 65 years old and 40 patients without nosocomial pulmonary fungal infection were retrospectively analyzed.Results Long-term use of broad-spectrum antibiotics and（or）glucocorticoid,hypoalbuminemia,neutropenia,smoking for a long time,and hospitalizations were risk factors for nosocomial pulmonary fungal infection in elderly COPD patients.In about 1/3 of patients,nosocomial pulmonary fungal infection occurred within one to two weeks of hospitalization.The clinical features were non-specific.Pathogens were mainly Candida albicans（80.55%）.Bronchial pneumonia and group block were the main findings in Chest X-ray.The prognosis was poor.Conclusion Elderly patients with COPD are prone to nosocomial pulmonary fungal infection if they have hypoproteinemia,neutropenia or use long-term broad-spectrum antibiotics and（or）glucocorticoids.