ICU老年患者肺部真菌感染的危险因素及抢先治疗临床分析

目的 探讨ICU老年患者肺部真菌感染的危险因素以及抢先治疗对其预后的影响.方法 2008年1月～2011年6月,本院ICU中达到临床诊断PFI标准的老年患者120例,分为A、B两组:A组59例,B组61例,A组给予伏立康唑,B组确诊后开始抗真菌治疗.记录B组病原菌检出时间,对两组患者进行APACHEⅡ评分、计算MODS发生率及病死率.结果 危险因素包括应用广谱抗生素、侵入性操作、机械通气时间≥7 d、ICU住院时间≥14 d、免疫功能低下、激素应用时间≥3 d、伴发糖尿病等；A组的MODS发生率、APACHEⅡ分值均明显低于B组(P＜0.05)、住院时间少于B组(P＜0.01).结论 抢先治疗ICU老年患者PFI可有效的改善预后,减少住院时间.

Risk factors of pulmonary fungal infection in elderly patients in intensive care units and the clinical analysis of preemptive therapy

Objective To investigate the risk factors of elderly patients with pulmonary fungal infection in intensive care units,and to evaluate the clinical effect of the preemptive therapy.Methods 120 cases of elderly patients in ICU who achieved clinical diagnosis standard of PFI from Jan.2008 to Jun.2011 were divided into group-A(59 cases) and group-B(61 cases).Group-A were treated with voriconazole,and group-B initiated antifungal therapy after diagnosis.The data were recorded on the pathogens detection time of group-B,and the APACHE Ⅱ scores,MODS incidence,the mortality rate of the both groups.Results The risk factors of PFI included the time of using broad-spectrum antibiotics,the invasive operation,mechanical ventilation time≥7 d,the time of staying in ICU≥14 d,immunocompromised,the time of using hormone≥3 d,or accompanied with diabetes mellitus;The incidence rate of MODS,APACHE Ⅱ scores of the group-A were significantly lower than those in the group-B(P<0.05),and the hospitalization time was less than that in the group-B(P<0.01).Conclusions Preemptive therapy can improve the prognosis of elderly patients in ICU with PFI,and decrease the hospitalization time.