呼吸道真菌感染诊疗控制的科研前后比较分析

目的把握相关科研对于呼吸道真菌感染诊疗控制实际的客观作用，发现存在的问题，提出持续改进建议。方法将研究结论基本上尚未通报全院之前的1996～2001年定为“研前”时段，将研究结论陆续通报全院之后的2002～2006年定为“研后”时段，并对2个时段中出院时确诊有呼吸道真菌感染的全部住院患者的病历资料进行统计和分析。结果科研前、后的呼吸道真菌感染患病率分别为0．737％和0．687％，下降6．78％，x^2=1．39，P〉0．2；病死率分别为23．92％和17．39％，下降27．30％，x^2=7．81，P〈0．01。抗生素（不含抗真菌药物）使用率分别为100％和99．7％，其中单联分别为22．2％和12．9％，双联分别为63．6％和76．9％，三联或超过三联分别为14．3％和9．9％；皮质激素或／和免疫抑制药物使用率分别为29．7％和24．3％。其升降交错，总体差别不大。入院前真菌感染患者分别占36．91％和44．31％，上升20．05％，x^2=6．38，P〈0．02。结论呼吸道真菌感染病原学诊断标准和易患因素研究促进了医院真菌感染诊疗控制水平的明显提高。降低真菌感染患病率，必须进一步切实规范抗生素（包括抗真菌药物）或／和免疫抑制药物的合理使用。

Comparative analysis of before and after the scientific research on the diagnosis and treatment of fungus infection in respiratory tract

Objective To grasp the objective role of the scientific research on the diagnosis and treatment of fungus infection in respiratory tract,identify existing problems and propose some advices. Methods We defined the duration（from 1996 to 2001） ,in which all people in our hospital were not notified the research conclusion,as the＂before research＂ period. Then,the duration （from 2002 to 2006）,in which all people in our hospital were notified the research conclusion,as the ＂after research＂ period. We performed a statistical analysis for the medical history data of all patients in hospital, who suffered from fungus infection in respiratory tract at the moment of leaving hospital during the two periods mentioned above. Results The morbidity of fungus infection in respiratory tract before and after the scientific research was 0. 737% and 0. 687% respectively,with 6. 78% of descending （x^2 =1.39,P〉0.2）; the case fatality was 23. 92% and 17. 39% respectively,with 27. 30% of descending （x^2 =7.81 ,P〈0.01）. The percentage of antibiotics （without antifungal agents） usage was 100% and 99.7 % respectively. In the two groups, 22.2% and 12.9% took only one kind of antimicrobial,63.6% and 76.9% took two kinds, 14.3% and 9.9% took three kinds or above respectively. The usage rate of corticosteroids and immunosuppressants was 29.7% and 24.3% respectively,with no significant difference. As the patients before admission were concerned, the usage rate of corticosteroids and immunosuppressants was 36.91% and 44.31% respectively,with 20.05% of elevation （x^2 = 6.38, P〈 0.02）. Conclusion The researches on respiratory fungus infection etiological diagnostic criteria and predisposing factors greatly improves the diagnosis and treatment of hospital-acquired fungus infection, lows the morbidity rate of fungus infection. Rational use of antimicrobials （including antifungal agents） and immunosuppressant should be emohasized on.