摘要：
Objective To investigate the risk factors of the secondary pulmonary fungal infections in ventilator associated pneumonia (VAP).Methods The clinical data of 186 cases of VAP with secondary pulmonary fungal infections were collected,the aging (＞ 70 years),gender,mechanical ventilation time,tracheotomy,aerosol inhalation were screened by the single factor analysis,then the logistic regression analysis was used to analyze these significant risk factors.Results The results of single factor analysis showed that 13 indicators such as aging (＞ 70 years),basic diseases,high blood glucose,hypoalbuminemia (ALB ＜ 30g/L),tracheotomy,mechanical ventilation time,radiation and/or chemotherapy,time of use of antibiotics,use of antibiotics jointly,glucocorticoid using time (≥ 7 d),the APACHE Ⅱ score,coma had significant correlation with secondary pulmonary fungal infections in VAP (P ＜ 0.05).Logistic regression analysis showed that aging,tracheotomy,mechanical ventilation time,time of use of antibiotics,use of antibiotics jointly,glucocorticoid using time (≥7 d),complicated with pulmonary disease were significantly correlated with secondary pulmonary fungal infections in VAP (P ＜0.05).Conclusions For the patients with aging,tracheotomy,long-time application of mechanical ventilation,antibiotics and glucocorticoid,use of antibiotics jointly,other pulmonary diseases,the more attention should be paid to pulmonary fungal infections,that will be benefited to early diagnosis and timely treatment,which can promote the prognosis.%目的 探讨呼吸机相关性肺炎(VAP)继发肺真菌感染的相关风险因素.方法 收集经临床确诊为VAP或VAP继发肺真菌感染患者186例,对高龄(＞70岁)、性别、机械通气时间、气管切开和雾化吸入等因素进行单因素分析,对有显著性相关的危险因素再纳入Logistic回归模型进行分析.结果 单因素分析结果显示:高龄(＞70岁)、合并基础疾病、血糖水平升高、低蛋白血症(白蛋白＜ 30g/L)、气管切开、机械通气时间、抗生素使用时间、联合应用抗生素、激素≥7 d、APACHEⅡ评分、昏迷等13项指标与VAP继发肺真菌感染皆呈显著相关性(P＜0.05);Logistic回归分析结果显示:高龄、气管切开、机械通气时间、抗生素使用时间、联合应用抗生素、激素(≥7d)、合并肺部疾病这7个因素与VAP继发肺真菌感染具有显著相关性(P＜0.05).结论 对于高龄、气管切开、机械通气时间长、长时间或联合使用抗生素、长时间激素应用、合并肺部疾病的患者,应注意继发肺真菌感染可能,以早期诊断、及时处理,达到改善预后的目的.
