颅脑损伤气管切开患者肺部真菌感染的影响因素
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摘要
目的探究颅脑损伤气管切开患者肺部真菌感染的影响因素,为临床预防及治疗提供参考依据。方法选择2016年5月到2018年12月在遵义医科大学第五附属(珠海)医院神经外科治疗的60例颅脑损伤气管切开术后肺部真菌感染患者为研究对象(研究组),另选取同期收治的60例颅脑损伤气管切开术后未发生肺部真菌感染的患者为对照组。分析研究组的病原菌种类及分布情况,并对患者进行耐药性测试。通过比较两组患者的基本情况,对研究组患者肺部真菌感染进行单因素分析,采用多因素Logistic回归分析患者肺部真菌感染的影响因素。结果研究组真菌检出种类中白色假丝酵母菌位居前列(51.67%),其次为光滑假丝酵母菌(21.67%),热带假丝酵母菌(11.67%);经单因素分析,糖尿病史、肝功能异常(ALT>120 U/L)等因素与颅脑损伤气管切开术后患者肺部真菌感染无关(P>0.05);低蛋白血症、入院时GCS评分<8分、联合应用抗菌药物、气管切开通气时间≥7 d、抗菌药物用药时间≥14 d等因素与颅脑损伤气管切开术后患者肺部真菌感染有关(P<0.05);经多因素Logistic回归分析结果显示,低蛋白血症、入院时GCS评分<8分、联合应用抗菌药物、气管切开通气时间≥7 d、抗菌药物用药时间≥14 d是影响患者肺部真菌感染的独立危险因素(P<0.05);白色假丝酵母菌、光滑假丝酵母菌、热带假丝酵母菌、曲霉菌等病原菌对氟康唑、伊曲康唑等药品的耐药性较高,对两性霉素B、制霉素菌等药物的耐药性较低。结论颅脑损伤气管切开术后患者极易发生肺部真菌感染,白色假丝酵母菌是最多被感染的病原菌。所有真菌对氟康唑等药物均有较高的耐药性,低蛋白血症、入院时GCS评分等因素都会对患者感染造成影响。在临床治疗中应加强对影响因素的预测控制并进行耐药性试验,对患者进行合理的治疗。
Objective To explore the influencing factors of pulmonary fungal infection in patients with craniocerebral injury undergoing tracheostomy, and to provide reference for clinical prevention and treatment. Methods Sixty patients with pulmonary fungal infection after tracheostomy for craniocerebral injury treated in neurosurgery of the Fifth Affiliated Hospital(Zhuhai) of Zunyi Medical University from May 2016 to December 2018 were selected as the research group, and another 60 patients without pulmonary fungal infection after tracheostomy for craniocerebral injury were selected as the control group. The types and distribution of pathogenic bacteria in the research group were analyzed, and the drug resistance of patients was tested. By comparing the basic situation of two groups of patients, univariate analysis of pulmonary fungal infection was conducted in the team study group, and multivariate Logistic regression was used to analyze the influencing factors of pulmonary fungal infection. Results In the research group, Candida albicans accounted for 51.67% of the fungi, followed by Candida tropicalis(21.67%) and Candida tropicalis(11.67%). By single factor analysis, history of diabetes mellitus and liver dysfunction(ALT>120 U/L) were not related to pulmonary fungal infection in patients with craniocerebral injury after tracheostomy(P>0.05); hypoproteinemia, Glasgow Coma Scale(GCS) score < 8 at admission, combined use of antibiotics, tracheostomy ventilation time(≥7 days) and antibiotics use time(≥14 days) were related to pulmonary fungal infection in patients with craniocerebral injury after tracheostomy(all P<0.05). Multivariate Logistic regression analysis showed that hypoproteinemia, GCS score<8 at admission,combined use of antibiotics, tracheostomy ventilation time(>7 days) and antibiotics use time(>14 days) were independent risk factors for pulmonary fungal infection. Candida albicans, Candida glabrata, Candida tropicalis, Aspergillus and other pathogenic bacteria have higher resistance to fluconazole, itraconazole and other drugs, but lower resistance to amphotericin B, nystatin and other drugs. Conclusion It was found that patients with craniocerebral injury after tracheostomy were susceptible to pulmonary fungal infection. Candida albicans was the most infectious pathogen. All fungi had high resistance to fluconazole and other drugs. Hypoproteinemia and GCS score at admission and other factors will affect the infection of patients. The influencing factors should be strengthened in clinical treatment. Predictive control and drug resistance test should be carried out to treat patients rationally.
Objective To explore the influencing factors of pulmonary fungal infection in patients with craniocerebral injury undergoing tracheostomy, and to provide reference for clinical prevention and treatment. Methods Sixty patients with pulmonary fungal infection after tracheostomy for craniocerebral injury treated in neurosurgery of the Fifth Affiliated Hospital(Zhuhai) of Zunyi Medical University from May 2016 to December 2018 were selected as the research group, and another 60 patients without pulmonary fungal infection after tracheostomy for craniocerebral injury were selected as the control group. The types and distribution of pathogenic bacteria in the research group were analyzed, and the drug resistance of patients was tested. By comparing the basic situation of two groups of patients, univariate analysis of pulmonary fungal infection was conducted in the team study group, and multivariate Logistic regression was used to analyze the influencing factors of pulmonary fungal infection. Results In the research group, Candida albicans accounted for 51.67% of the fungi, followed by Candida tropicalis(21.67%) and Candida tropicalis(11.67%). By single factor analysis, history of diabetes mellitus and liver dysfunction(ALT>120 U/L) were not related to pulmonary fungal infection in patients with craniocerebral injury after tracheostomy(P>0.05); hypoproteinemia, Glasgow Coma Scale(GCS) score < 8 at admission, combined use of antibiotics, tracheostomy ventilation time(≥7 days) and antibiotics use time(≥14 days) were related to pulmonary fungal infection in patients with craniocerebral injury after tracheostomy(all P<0.05). Multivariate Logistic regression analysis showed that hypoproteinemia, GCS score<8 at admission,combined use of antibiotics, tracheostomy ventilation time(>7 days) and antibiotics use time(>14 days) were independent risk factors for pulmonary fungal infection. Candida albicans, Candida glabrata, Candida tropicalis, Aspergillus and other pathogenic bacteria have higher resistance to fluconazole, itraconazole and other drugs, but lower resistance to amphotericin B, nystatin and other drugs. Conclusion It was found that patients with craniocerebral injury after tracheostomy were susceptible to pulmonary fungal infection. Candida albicans was the most infectious pathogen. All fungi had high resistance to fluconazole and other drugs. Hypoproteinemia and GCS score at admission and other factors will affect the infection of patients. The influencing factors should be strengthened in clinical treatment. Predictive control and drug resistance test should be carried out to treat patients rationally.
引文
[1]熊丽,张莹,刘斌,等.重症颅脑损伤患者气管切开术后继发肺部真菌感染的危险因素分析[J].中国药房,2018,29(8):1073-1078.
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[9]宋凌霞,张咏梅,曾芬莲,等.重型颅脑损伤患者医院获得性肺部感染危险因素的Meta分析[J].现代预防医学,2016,43(8):1523-1526.
[10]耿保伟,原茹艳,廖鹏,等.重症颅脑损伤患者呼吸道分泌物病原学监测及其耐药性分析[J].中国病原生物学杂志,2017,12(7):675-679.
[11]CORITSIDIS G,DIAMOND N,RAHMAN A,et al.Hypertonic saline infusion in traumatic brain injury increases the incidence ofpulmonary infection[J].J Clin Neurosci,2015,22(8):1332-1337.
[12]何昊,吴勇,梁亮.颅脑外科手术患者手术部位感染的危险因素分析[J].重庆医学,2017,46(3):385-387.
[13]李天泉,张伟,周恩瑜.开放性颅脑损伤的临床特点及预后因素分析[J].中国现代医学杂志,2015,25(17):89-93.
[14]毛瑞,董乐,杨美娟,等.颅脑外伤患者术后肺部感染危险因素及病原菌药敏情况研究[J].中华医院感染学杂志,2017,27(6):1289-1292.
[15]翟红燕,张启田,梁青.重症颅脑损伤患者发生肺部感染的危险因素及防治[J].中国感染控制杂志,2017,16(2):182-185.
[16]杜晓光,董保忠,李琛,等.ICU重型颅脑损伤患者肺部感染的影响因素与抗菌药物使用情况研究[J].中华医院感染学杂志,2017,27(22):5145-5148.
[17]张继跃,王瑞玲,刘慧君.颅脑外伤患者医院感染的病原学及危险因素分析[J].中国病原生物学杂志,2018,13(8):889-892.
[2]杨欣刚,安海龙,马修尧,等.重型颅脑损伤患者气管切开术后肺部感染特点与危险因素分析[J].中华医院感染学杂志,2016,26(2):323-325.
[3]周有泠,向群,陈丹丹,等.重症颅脑损伤患者发生肺部感染的危险因素及其预防[J].现代预防医学,2018,45(20):3832-3836.
[4]易有峰,王晓娟.重症颅脑损伤患者肺部真菌感染的耐药性分析[J].现代预防医学,2015,42(5):942-944.
[5]符永华,王兰,陈翠云.重症颅脑损伤患者肺部感染的危险因素[J].中国感染控制杂志,2018,17(9):783-787.
[6]卜玲,陈顺芳,李志红.手术室护理干预对颅脑损伤患者术后医院感染的控制作用研究[J].中华医院感染学杂志,2015,25(15):3499-3500,3527.
[7]朱华云,彭胜.重型颅脑损伤患者气管切开术后肺部感染危险因素分析[J].中国消毒学杂志,2015,32(1):82-83.
[8]王莉,曲鑫,王春亭,等.重型颅脑损伤患者气管切开术后肺部感染的危险因素分析[J].中华医院感染学杂志,2015,25(20):4725-4727.
[9]宋凌霞,张咏梅,曾芬莲,等.重型颅脑损伤患者医院获得性肺部感染危险因素的Meta分析[J].现代预防医学,2016,43(8):1523-1526.
[10]耿保伟,原茹艳,廖鹏,等.重症颅脑损伤患者呼吸道分泌物病原学监测及其耐药性分析[J].中国病原生物学杂志,2017,12(7):675-679.
[11]CORITSIDIS G,DIAMOND N,RAHMAN A,et al.Hypertonic saline infusion in traumatic brain injury increases the incidence ofpulmonary infection[J].J Clin Neurosci,2015,22(8):1332-1337.
[12]何昊,吴勇,梁亮.颅脑外科手术患者手术部位感染的危险因素分析[J].重庆医学,2017,46(3):385-387.
[13]李天泉,张伟,周恩瑜.开放性颅脑损伤的临床特点及预后因素分析[J].中国现代医学杂志,2015,25(17):89-93.
[14]毛瑞,董乐,杨美娟,等.颅脑外伤患者术后肺部感染危险因素及病原菌药敏情况研究[J].中华医院感染学杂志,2017,27(6):1289-1292.
[15]翟红燕,张启田,梁青.重症颅脑损伤患者发生肺部感染的危险因素及防治[J].中国感染控制杂志,2017,16(2):182-185.
[16]杜晓光,董保忠,李琛,等.ICU重型颅脑损伤患者肺部感染的影响因素与抗菌药物使用情况研究[J].中华医院感染学杂志,2017,27(22):5145-5148.
[17]张继跃,王瑞玲,刘慧君.颅脑外伤患者医院感染的病原学及危险因素分析[J].中国病原生物学杂志,2018,13(8):889-892.
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