【作者】 张静；

【导师】 谷秀；

【作者基本信息】 中国医科大学 ， 呼吸内科（专业学位）， 2019， 硕士

【摘要】 目的:外科手术是现代医学中非常重要的诊断与治疗方法,可达到切除病变组织、修复损伤等目的。手术操作会切开机体第一层保护屏障,破坏正常组织结构,并可能将病原体带入深部组织。感染是术后常见的并发症,其中真菌所导致的感染占到很大比例。分析术后合并念珠菌血症患者的临床特征,并将不同预后患者进行比较,探讨影响术后合并念珠菌血症患者预后的相关因素,为临床工作提供依据。方法:对中国医科大学附属盛京医院2014年-2018年手术后3周内合并念珠菌血症并且资料完整的病例进行回顾分析,调查其一般情况、真菌种类、耐药情况、基础疾病、治疗情况等临床资料,对手术后合并念珠菌血症患者可能的预后影响因素进行单因素及多因素统计分析。结果:本次研究一共收集了手术后合并念珠菌血症患者114例,出院时病情好转者79例(69.30%);预后不佳患者为35例(30.70%);其中死亡患者18例(15.79%),治疗效果不佳退院患者17例(14.91%)。114例患者血液标本中分离出近平滑念珠菌最多,为43例(37.72%),其后分别为白色念珠菌38例(33.33%),光滑念珠菌16例(14.04%)。单因素分析发现患者的血红蛋白水平、白蛋白水平、留置胃管与静脉导管时间、是否入住重症监护病房治疗、血肌酐水平、是否进行机械通气、是否使用肾脏替代治疗对手术后合并念珠菌血症患者的预后有影响,将上述影响因素引入logistic回归方程,结果提示血红蛋白水平降低(95%CI0.92~0.99,P=0.01)、血肌酐水平升高(95%CI1.00~1.02,P=0.04)、静脉置管时间长(95%CI1.00~1.12,P=0.04)是影响该类患者预后独立危险因素。结论:手术后合并念珠菌血症患者的预后与多种因素相关,加强术后患者与之相关的管理,能够改善手术后合并念珠菌血症患者的预后。更多还原

【Abstract】 Objective: Surgery is a very important diagnosis and treatment method in modern medicine,which can achieve the purpose of removing diseased tissue and repairing damage.The surgical procedure cuts the first layer of the protective barrier,destroys the normal tissue structure,and may carry the pathogen into the deep tissue.Infection is a common postoperative complication,and fungal infection accounts for high proportion.This study aims to analyze the clinical features of postoperative patients with candidemia,to compare patients with different prognosis,to explore the prognostic factors of postoperative patients with candidemia,and to provide evidence for clinical work.Methods:Collection and Retrospective analysis of cases with candidemia within 3 weeks after surgery with complete data from 2007 to 2018 of Shengjing Hospital of China Medical University was carried out,information of these cases was collected including the general situation,fungal species,drug resistance,underlying diseases,treatment,etc.univariate and multivariate statistical analysis of possible prognostic factors in postoperative patients with candidemia was made.Results: In this study,a total of 114 patients with postoperative candidemia were collected,79 patients(69.30%)were cured at the time of discharge from hospital,and 35 patients(30.70%)had poor prognosis;18 patients(15.79%)died.There were 17 patients(14.91%)canceling hospitalization who had poor therapeutic effect.Among the 114 patients,the most common cases were candida parapsilosis,which was 43 cases(37.72%),followed by 38 cases of Candida albicans(33.33%)and 16 cases of Candida glabrata(14.04%).Univariate analysis found that patients’ hemoglobin levels,albumin levels,indwelling gastric tube and venous catheter time,whether in the intensive care unit treatment,serum creatinine level,mechanical ventilation and the use of renal eplacement therapy had an influence on prognosis.The above influencing factors are introduced into the logistic regression equation.The results suggest that the decrease of hemoglobin level(95%CI0.92~0.99,P=0.01),elevated serum creatinine level(95%CI1.00~1.02,P=0.04)and long time of venous atheterization(95%CI1.00~1.12,P=0.04)are independent risk factors for the prognosis of these patients.Conclusion:The prognosis of patients with operative candidemia is related to a variety of factors.strengthening the management of postoperative patients can improve the prognosis of patients with operative candidemia.更多还原