【摘要】 目的　研究危重病患者获得性真菌血症的发生特点及其防治策略。方法　收集近 3年来上海长征医院综合性 ICU住院患者获得性真菌血症 5 4例进行回顾性分析。结果　 5 4例患者血微生物培养共获得真菌菌株 6 0株 ,念珠菌是主要病原体 ,占 86 .7% ;6例 (11.1% )为两种真菌混合感染 ;2 2例 (4 0 .7% )伴随细菌血症 ;总病死率6 8.5 % ,真菌血症相关病死率治疗组 2 8.9% ,未治疗组 88.9% ,两组比较 χ2 =11.2 6 8,P<0 .0 1;两性霉素 B及氟康唑治疗有效率分别为 6 8.8%和 70 .8% ,两者联合治疗有效率为 80 .0 %。结论　真菌感染己成为 ICU内危重病患者死亡的重要原因 ;消除易患因素、重视真菌感染的监测、及时合理地抗真菌治疗是降低危重病患者获得性真菌感染发病率及病死率的重要措施 ;氟康唑及两性霉素 B仍是目前治疗深部真菌感染的有效药物更多还原

【Abstract】 OBJECTIVE To study the clinical characteristics,prevention and treatment of nosocomial fungemia.METHODS Fifty four consecutive patients with nosocomial fungemia were studied in clinical retrospective manner.RESULTS Sixty fungal strains were isolated from blood.Candida was the predominant pathogenic organism(86.7%),6 cases had mixed infection causing by two fungal species(11.1%).Twenty two cases had concomitant bacteremia(40.7%).Overall mortality rate was 68.5%,directly related mortality rate in treatment group was significantly lower than that in nontreatment one(28.9% vs.88.9%,χ 2 =11.268,P<0.01).Effective rate of amphotericin B was 68.8%,fluconazole 70.8%,combined treatment 80.0%.CONCLUSIONS Fungal infection has become prominently fatal cause of critically ill patients.Removing predisposing factors,monitoring fungal pathogen and effective antifungal therapy are important measures to reduce the incidence and mortality of fungal infection.Fluconazole and amphotericin B are effective drugs of treating deep fungal infection.更多还原