摘要: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378%,主要感染部位为泌尿系(218%),呼吸道(269%),消化道(409%)。慢性阻塞性肺疾病(498%)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(962%)和糖皮质激素(332%)、营养状况不良(583%)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626%。氟康唑治疗有效率914%。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612%和082%,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。Abstract: Objective: To study the susceptible factors,clinical features and treatments of nosocomial pulmonary fungal infection in the ward of respiratory department.〖WTHZ〗Methods : The chart files of 49 patients with nosocomial pulmonary fungal infection admitted from January 2002 to June 2008 in the ward of Respiratory Department were reviewed. Results : The incidence rate of nosocomial pulmonary fungal infection was 378%.COPD(498%)was the main predisposing disease,and candidiasis(626%) was the most common pathogen. The main susceptible factors associated with nosocomial pulmonary fungal infection are longterm use of broadspectrum antibiotics(962%),hypoalbuminemia(583%),longterm use of adrenocortical steroid(332%),and diabetes mellitus.There is no specific clinical feature.Fluconazole(914%)is more efficient in the treatment.〖WTHZ〗Conclusion : Nosocomial pulmonary fungis are important pathogenin the secondary infection in respiratory disease.The most common pathogen is candida albicans.Combined therapy as well as treating fungus infection are important measures to increase the cure rate of nosocomial pulmonary fungal infection.
Objective To investigate the risk factors of positive yield in sputum fungal culture in patients with chronic obstructive pulmonary disease ( COPD) . Methods The patients with COPD who hospitalized in the respiratory departments of Shanghai First People’s Hospital, Zhongshan Hospital, and Huadong Hospital from January 2005 to December 2007 were analyzed retrospectively. Results The 78 patients were grouped according to the results of sputumfungal culture. There were no significant differences in sex, age, history of smoking, diabetes, atomization inhalation, and the accumulated doses of oral corticosteroids between the positive group and the negative group ( P gt; 0. 05) . However, the differences in species of antibiotics, duration of antibiotic therapy, and accumulated doses of intravenous corticosteroidswere significant ( P lt; 0. 01) . The logistic analysis showed that prolonged high-dose of corticosteroids and multiple broad-spectrum antibiotics were risk factors of the positive yield of sputum fungal culture ( P lt;0. 05) . Conclusion Prolonged high-dose of corticosteroids and multiple broad-spectrum antibiotics are riskfactors of fungal colonization in lower respiratory tract of COPD patients.
目的:观察口服伊曲康唑治疗皮肤浅部真菌感染的疗效及安全性。方法: 选择200例临床及真菌学确诊皮肤浅部真菌感染患者,分为手足癣和体股癣治疗组。手足癣组口服伊曲康唑200mg,bid;体股癣组口服200mg,qd,均连服7天,停药3周后评价疗效。结果: 手足癣治疗组痊愈率、总有效率和真菌清除率分别为59.38%、82.81%和92%;体股癣治疗组分别为68.06%、87.50%和94%。总不良反应发生率为5.5%。结论: 口服伊曲康唑治疗皮肤浅部真菌病临床疗效好,可靠安全。