【摘要】 真菌广泛存在于人类生存环境，一般情况下不致病，但当机体抵抗力降低或出现促使真菌生长繁殖的条件时，则其可侵入组织而发病。青岛大学附属医院重症监护病房（ICU）于2021年8月17日收治1例70岁女性急性消化道穿孔并继发腹腔感染患者，入院后经急症剖腹探查并进行胃穿孔修补术、小肠部分切除术、腹腔冲洗引流术、空肠营养造口术后，给予亚胺培南西司他丁钠抗感染治疗，患者病情仍进展，合并肠毒性休克和多器官功能障碍综合征。在原有抗感染、抗休克、连续性肾脏替代治疗（CRRT）、有创呼吸机辅助通气基础上立即加用抗真菌药物治疗后患者病情迅速好转。入住ICU 5 d后，获得入院时血培养结果显示为白色念珠菌，8 d后胃幽门管穿孔边缘病理学切片结果显示大量念珠菌，小肠溃疡病理学切片显示大量毛霉菌。本例患者ICU成功救治的关键在于：当消化道穿孔患者经有效外科干预和经验性抗细菌治疗后，病情仍进展时要考虑侵袭性真菌感染的可能，应及时进行真菌感染相关检查，可借助真菌感染危险性评分系统快速指导诊断、尽早加用抗真菌治疗。更多还原

【Abstract】 Fungi are widely present in the human environment and generally non-pathogenic.However,they may invade tissues and cause disease when host immunity is compromised or conditions conducive to fungal proliferation arise.A case of a 70-year-old woman with acute gastrointestinal perforation and secondary abdominal infection,admitted to the department of intensive care medicine(ICU) of the Affiliated Hospital of Qingdao University on August 17,2021 was enrolled.Following emergency exploratory laparotomy with gastric perforation repair,partial small bowel resection,peritoneal lavage drainage,and jejunal feeding jejunostomy,the patient received imipenem and cilastatin sodium antimicrobial therapy.Despite these interventions,clinical deterioration ensued with septic shock and multiple organ dysfunction syndrome.Prompt initiation of antifungal therapy alongside existing anti-infective treatment,antishock management,continuous renal replacement therapy(CRRT),and invasive mechanical ventilation led to rapid clinical improvement.Notably,blood cultures obtained at admission revealed Candida albicans after 5 days in ICU,while pathological examination of gastric pyloric perforation margins(8 days post-admission) demonstrated abundant Candida and small bowel ulcer sections showed extensive Mucor infiltration.This case highlights critical lessons in ICU management:Invasive fungal infection should be strongly suspected when gastrointestinal perforation patients deteriorate despite adequate surgical intervention and empirical antibacterial therapy;Timely fungal diagnostic workup should be initiated,utilizing validated fungal infection risk assessment tools to guide rapid diagnosis;Early empirical antifungal therapy proves crucial for improving outcomes in such critical scenarios.更多还原