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学科主题急诊医学
呼吸机相关真菌性肺炎的临床预测因素
其他题名The clinical predictive factors of ventilator-associated fungal pneumonia in emergency intensive care unit
张玉梅; 郑亚安; 李硕; 葛洪霞; 宁永忠; 马青变
关键词急诊重症监护病房 呼吸机相关真菌性肺炎 预测因素 Logistic回归 Emergency intensive care unit Ventilator-associated fungal pneumonia Predictive factor Logistic regression analysis
刊名中华急诊医学杂志
2015
DOI10.3760/cma.j.issn.1671-0282.2015.05.021
24期:5页:541-546
收录类别中国科技核心期刊 ; 中文核心期刊 ; CSCD
文章类型Journal Article
摘要目的 探讨急诊重症监护病房呼吸机相关性肺炎患者真菌感染的临床预测因素.方法 回顾性分析2009年7月至2014年6月入住北京大学第三医院急诊重症监护病房16岁以上呼吸机相关性肺炎(VAP)患者,排除中途放弃治疗或机械通气未超过48 h者.根据能否从呼吸道分泌物中镜检或培养出真菌,将人选患者分为呼吸机相关性肺炎非真菌组(VANFP)和真菌组(VAFP).检出同一真菌菌种两次以上为阳性.资料用非配对t检验、x2检验及Logistic多因素逐步回归等方法进行分析.结果 共纳入197例患者.发生VAFP 63例,发生率为32.0%;主要的致病真菌为白色念珠菌、光滑念珠菌和热带假丝酵母菌.单因素分析发现多种临床因素有预测VAFP价值.多因素Logistic回归分析发现,急性生理及慢性健康Ⅱ(APACHEⅡ)评分≥22、放化疗、机械通气≥14.11 d、抗生素使用≥14 d、使用激素等免疫抑制剂,对VAFP的发生具有独立预测价值.结论 APACHEⅡ评分、放化疗、长时间机械通气、抗生素使用、使用激素等免疫抑制剂为急诊监护病房呼吸机相关性肺炎患者发生真菌感染的独立预测因素.积极改善患者整体情况、尽早脱机、缩短抗生素的使用、谨慎使用激素和免疫抑制剂等措施可能降低VAFP的发生. Objective To explore the clinical risk factors of ventilator-associated fungal pneumonia (VAFP) in emergency intensive care unit.Methods One hundred and ninety-seven consecutive patients with 121 males and 76 females,aged from 17 to 98 years met the criteria of ventilator-associated pneumonia in emergency intensive care unit admitted from July 2009 to June 2014,were retrospectively evaluated.Those with mechanical ventilation less than 48 hours or treatment discontinued were excluded.Patients were divided into VAFP group and ventilator-associated non-fungal pneumonia group according to the results of fungal culture and microscopy.Univariate analysis was used to find out preliminary risk factors for VAFP,and then the ultimate independent risk factors were determined with multivariate stepwise logistic regression analysis.Results The occurrence of VAFP was 32.0 % (63 cases) out of 197 patients with ventilatorassociated pneumonia.In those 63 patients,there were 71 species found from fungus culture.Candida albicans counted for 33 (46.5%),Candida glabrata for 11 (15.5%),other Candida Albicans for 26 (36.6%).The preliminary univariate analysis showed that 19 factors were statistically significant,while multivariate stepwise logistic regression analysis revealed that acute physiology and chronic health evaluation Ⅱ score≥ 22,radiotherapy or chemotherapy,mechanical ventilation ≥14.11 days,use of antibiotics ≥14 days,use of glucocorticoid and other immuno-suppressants were independent predictors of VAFP,and the adjusted odds ratios with 95% confidential intervals were 4.133 (2.831-6.033),2.977 (1.942-4.564),2.305 (1.439-3.736),1.988 (1.441-2.741),1.528 (1.337-1.746),respectively.Conclusion Higher APACHE Ⅱ score,radiotherapy or chemotherapy,prolonged use of mechanical ventilation,prolonged use of antibiotics,use of glucocorticoid and immunosuppressants are independent risk factors of VAFP.The incidence rate of VAFP may be reduced by improving patients' overall clinical setting,shortening the duration of mechanical ventilation and employment of antibiotics,and more strict guidelines to the application of glucocorticoid and immunosuppressants.
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文献类型期刊论文
条目标识符http://ir.bjmu.edu.cn/handle/400002259/71430
专题北京大学第三临床医学院_急诊科
作者单位1.北京大学第三医院急诊科, 北京,100191
2.北京大学第三医院检验科, 北京,100191
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张玉梅,郑亚安,李硕,等. 呼吸机相关真菌性肺炎的临床预测因素[J]. 中华急诊医学杂志,2015,24(5):541-546.
APA 张玉梅,郑亚安,李硕,葛洪霞,宁永忠,&马青变.(2015).呼吸机相关真菌性肺炎的临床预测因素.中华急诊医学杂志,24(5),541-546.
MLA 张玉梅,et al."呼吸机相关真菌性肺炎的临床预测因素".中华急诊医学杂志 24.5(2015):541-546.
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