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目的探讨肝衰竭并发医院内真菌感染的临床特点及预防、治疗对策。方法回顾性分析2010年1月—2015年6月收治的肝衰竭患者的临床资料。结果肝衰竭并发医院内真菌感染发生率为10.1%(36/357),住院超过40d者感染率17.0%,明显高于住院时间小于40 d者的6.9%(P<0.01);感染部位以肠道居多(65.9%),其次为下呼吸道(17.1%);病原菌以白色念珠菌为主(59.6%),其次为光滑念珠菌(14.9%);50%并发医院内真菌感染者外周血白细胞或中性分叶核粒细胞比例升高,38.9%出现不同程度发热;36例合并真菌感染者均接受过抗菌药物及侵入性操作;发生真菌感染的肝衰竭患者病死率55.6%,明显高于未发生感染真菌者的19.0%(P<0.01)。结论肝衰竭患者发生医院内真菌感染率和病死率高,白色念珠菌为主要病原菌,早期发现以及有效地治疗真菌感染是提高肝衰竭患者生存率的重要手段。
Objective To investigate the clinical features, prevention and treatment of fungal infection in hospital with liver failure. Methods The clinical data of patients with liver failure admitted from January 2010 to June 2015 were retrospectively analyzed. Results The incidence of nosocomial fungal infections was 10.1% (36/357) in patients with liver failure, 17.0% in patients who were hospitalized for more than 40 days, significantly higher than 6.9% in patients with less than 40 days of hospitalization (P <0.01) (65.9%), followed by lower respiratory tract (17.1%); Candida albicans was the main pathogen (59.6%), followed by Candida glabrata (14.9%); 50% of patients with fungal infection in peripheral blood leucocytes or Neutrophil granulocyte ratio increased, 38.9% of varying degrees of fever; 36 patients with fungal infections were treated with antibiotics and invasive procedures; fungal infection in liver failure patients with mortality was 55.6%, significantly higher than the 19.0% of those infected with fungi (P <0.01). Conclusion The prevalence of hospital infection and mortality in patients with liver failure is high, Candida albicans is the main pathogen. Early detection and effective treatment of fungal infections are important means to improve the survival rate of patients with liver failure.