目的:探讨重症脑血管病病人并发肺部真菌感染的高危因素。方法: 分析我院2013－01 ～ 2016－12
重症医学科收治的109 例重症脑血管病( 均需机械通气) ，且合并肺部感染病人的临床资料，对其并发肺部真菌
感染的高危因素进行统计分析。结果: 65 例痰标本未检测到真菌，占59．6%，44 例痰标本显示合并肺部真菌感染
的病人均为假丝酵母菌属感染，尤以白色假丝酵母菌居多，占22．9%，其次是热带假丝酵母菌，占14．7%。统计结
果显示:重症脑血管病病人并发肺部真菌感染与病人的年龄、GCS 评分、糖尿病、基础肺病、入住ICU 时间、呼吸
机使用时间、纤支镜检查次数及APACHEⅡ评分具有相关性( P＜0．05) ，且与预后显著相关( P＜0．01) ，而与病人
的性别、吸烟及冠心病无相关性( P＞0．05) ; 44 例重症脑血管病合并肺部真菌感染的病人经积极治疗后，好转35
例，占79．5%;病情严重死亡9 例，占20．5%，而9 例死亡的病人中，白色假丝酵母菌感染者只有1 例。结论: 加强
对高龄伴意识障碍脑血管病病人的气道管理、调控血糖，争取尽早脱机拔管离开ICU，尽量减少呼吸道侵入性操
作，对预防重症脑血管病人并发肺部真菌感染具有重要的临床意义;重症脑血管病合并肺部真菌感染，以假丝酵
母菌属感染为主，而死亡的病人则以非白色假丝酵母菌感染者居多。

Objective: To investigate the risk factors of pulmonary fungal infection in patients with
severe cerebrovascular disease．Methods: Analysis of the clinical data about 109 patients with severe
cerebrovascular disease who were required mechanical ventilation and complicated with pulmonary infection
was carried out at the Department of critical care medicine from January 2013 to December 2016
in our hospital，and analyzed statistically the risk factors of pulmonary fungal infection．Ｒesults: Fungi
were not detected in sputum samples of 65 patients，accounting for 59．6%．44 cases of sputum showed
that all patients with pulmonary fungal infection were Candida infection，in particular，the majority of
Candida albicans accounting for 22．9%，followed by Candida tropicalis accounting for 14．7%．Statistical
findings indicate that patients with severe cerebrovascular disease complicated with pulmonary fungal
infection was correlated with age，GCS scores，diabetes，basal lung disease，check in time at ICU，ventilator
use time，the number of using fiberoptic bronchoscopy and APACHE II scores( P＜0．05) ，and sig-
nificant correlation with prognosis ( P ＜ 0．01) ，there was no correlation with gender，smoking and
coronary heart disease ( P ＞ 0．05 ) ． 44 cases of severe cerebrovascular disease complicated with
pulmonary fungal infection，after active treatment，improved in 35 cases accounting for 79．5%，9 cases
die accounting for 20．5%，among the 9 patients who died Candida albicans were only one．Conclusion:
To strengthen the airway management about of the elderly patients with cerebrovascular disease and
with disorders of consciousness，control of blood glucose，stop mechanical ventilation and remove endotracheal
tube and leave from ICU as early as possible，reduce respiratory tract invasive operation，to prevent
of severe cerebrovascular patients with pulmonary fungal infection has important clinical significance．
Candida infection is the main in severe cerebrovascular disease complicated with pulmonary fungal
infection，Candida albicans infection is a small cause of death．

Ｒ446

 收稿日期: 2018－03－10; 修回日期: 2018－07－05
基金项目:深圳市龙岗区医疗卫生科技计划项目( 20160606151235244)
作者简介:王美霞( 1972－) ，女，广东省深圳市龙岗中心医院重症医学科副主任医师，医学硕士。