本文選題：回顧性研究　切入點：侵襲性真菌感染　出處：《石河子大學》2014年碩士論文

【摘要】：目的：調查入住石河子地區(qū)某醫(yī)院重癥醫(yī)學科（ICU）患者侵襲性真菌感染（IFI）的發(fā)病特點，致病真菌的耐藥情況，抗真菌藥物治療情況及效果。分析ICU病房IFI感染的危險因素，評價抗真菌藥物使用規(guī)范性、合理性，為防治IFI的合理用藥提供參考依據。 方法：采用回顧性調查研究的方法，將2012年1月～2013年12月入住ICU經篩選符合條件的患者作為研究對象，調查分析IFI患者的一般情況、致病真菌的分離培養(yǎng)及藥敏試驗結果、使用抗真菌藥物情況，治療轉歸等。參照藥品說明書及相關真菌病治療指南，建立抗真菌藥物應用評價標準，對臨床應用抗真菌藥物的合理性進行評價，開展抗真菌藥物的利用評價。以臨床診斷及確診患者為IFI組，隨機選取非IFI患者為對照組，用病例對照研究方法，分析ICU患者發(fā)生IFI的危險因素，利用SPSS軟件進行Logistic回歸分析，篩選出主要的獨立危險因素。 結果：符合調查條件的546例患者中發(fā)現113例IFI患者，發(fā)病率為20.70%，其中確診7例，臨床診斷71例，擬診35例。從血液、尿液、痰液、胸腹水、傷口分泌物等標本中共分離出菌株61株均為酵母菌，其中白色假絲酵母菌49株（80.33%）。藥敏試驗結果顯示不同藥物對真菌的敏感性有明顯的差異。107例患者行抗真菌藥物治療，其中經驗治療33例，搶先治療67例，目標治療7例。共有氟康唑、伏立康唑、兩性霉素B、卡泊芬凈等4種藥物被使用，其中藥物單用84例，聯合用藥23例。評價了治療1周以上的82例患者治療效果，總有效率分為40.24%，病死率為25.61%。調查應用抗真菌藥物治療病歷109例，藥物應用評價結果合理101例(92.7%)，藥物利用評價顯示氟康唑使用頻次最高，藥物利用指數也最高。分析了IFI感染的17項因素均為患者發(fā)生IFI的危險因素，其中6項有統計學意義，經多重回歸分析，篩選出膿毒癥（感染性休克）、腫瘤、使用廣譜抗生素≥5天、深靜脈置管、機械通氣≥3天等5項為獨立危險因素。 結論：ICU患者IFI發(fā)病率較高，已成為ICU常見感染性疾病，但絕大多數IFI難以確診，多數患者接受抗真菌治療是在擬診及臨床診斷的基礎上，急需統一規(guī)范治療標準。感染病原菌以白假絲酵母菌最常見，對兩性霉素B的敏感性較好，對其它常用藥有不同程度耐藥。IFI治療的主要策略是經驗性用藥及搶先治療，可選擇藥物少，治療效果有待提高。以自擬的抗真菌藥物臨床應用評價標準評價，ICU應用抗真菌藥物合理性較高，多數藥物利用指數DUI1.0，結果符合診療發(fā)展的趨勢。研究顯示常用藥物DDC較大，患者經濟負擔重�？疾斓�17項因素，ICU患者發(fā)生IFI的危險因素多，與原發(fā)疾病、并發(fā)癥及侵入性診治，，抗菌藥物應用等有關。經多因素Logistic回歸分析篩選出5項獨立危險因素，結論僅供參考。應對侵襲性真菌感染的診斷與藥物治療等加以深入研究。
[Abstract]:Objective: to investigate the characteristics of invasive fungal infection (IFI), the drug resistance of pathogenic fungi, and the treatment of antifungal drugs in patients with ICU in a hospital in Shihezi area.To analyze the risk factors of IFI infection in ICU ward, to evaluate the standardization and rationality of antifungal drug use, and to provide a reference for the prevention and treatment of IFI.Methods: a retrospective study was conducted to investigate and analyze the general conditions of IFI patients, the isolation and culture of pathogenic fungi and the results of drug sensitivity test.Use of antifungal drugs, treatment outcome and so on.According to the drug instructions and the guidelines for the treatment of mycosis, the evaluation criteria for the application of antifungal drugs were established, the rationality of the clinical application of antifungal drugs was evaluated, and the utilization evaluation of antifungal drugs was carried out.The patients with clinical diagnosis and diagnosis were selected as IFI group and non-#en1# patients were randomly selected as control group. The risk factors of IFI in ICU patients were analyzed by case-control study. The main independent risk factors were screened by Logistic regression analysis with SPSS software.Results: 113 cases of IFI were found out of 546 patients who met the conditions of investigation, the incidence rate was 20.70,7 cases were diagnosed, 71 cases were clinically diagnosed, and 35 cases were to be diagnosed.A total of 61 strains were isolated from blood, urine, sputum, pleural effusion and wound secretion, among which 49 strains were Candida albicans.The results of drug sensitivity test showed that there were significant differences in the sensitivity of different drugs to fungi. 107 patients were treated with antifungal drugs. Among them, 33 cases were treated by experience, 67 cases by preemptive treatment, and 7 cases by target therapy.Four kinds of drugs, fluconazole, volconazole, amphotericin B and carpofen, were used, among which 84 cases were used alone and 23 cases were treated in combination.82 patients who had been treated for more than one week were evaluated. The total effective rate was 40.24 and the mortality was 25.61.109 cases were treated with antifungal drugs. The results of evaluation were reasonable in 101 cases. The drug utilization evaluation showed that fluconazole use frequency was the highest and drug utilization index was the highest.All the 17 factors of IFI infection were analyzed as the risk factors of IFI in the patients. Six of them were statistically significant. Sepsis (septic shock, tumor, broad-spectrum antibiotic 鈮

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