摘要
目的通过分析与鉴定重症监护病房（ICU）建立人工气道的重症患者胃液pH值与真菌类型及耐药情况，探讨ICU患者胃液pH值与真菌的直接关系及临床意义。方法采用前瞻性研究方法，选择160例深圳大学第一附属医院ICU2008年12月至2011年10月收治的建立人工气道〉48h的重症患者。通过鼻胃管收集其胃液样本，用精密pH试纸测定胃液pH值；依胃液酸度将样本分为pH值≤2．0、pH值2．1～3．0、pH值3．1～4．0、pH值4．1～5．0、pH值5．1—6．0、pH值6．1～7．0组；同时进行胃液真菌培养及常用抗真菌药物敏感试验，分析胃液酸度对胃液真菌培养阳性率的影响；再按照患者28d存活情况分成存活组（102例）和死亡组（58例），分析组间胃液真菌分布及临床意义。结果①胃液pH值〈4．0时，几乎无真菌生长；随着胃液pH值的增大，真菌培养阳性率明显升高。②胃液总样本真菌培养阳性率为27．9％（55／197），其中白色念珠菌与非白色念珠菌培养阳性率分别为38．2％（21／55）和61．8％（34／55），差异有统计学意义（X2=4．16，P〈0．05）。③存活组与死亡组真菌培养检出率分别为40．0％（22／55）和60．O％（33／55），其中存活组白色念珠菌与非白色念珠菌分别为54．5％（12／22）和45．5％（10／22），死亡组白色念珠菌与非白色念珠菌分别为27．3％（9／33）和72．7％（24／33）。白色念珠菌与非白色念珠菌耐药率分别在4．7％～14．3％（平均10．1％）和0—60．O％（平均28．5％）。结论建立人工气道的重症患者胃液真菌培养阳性率随着胃液pH值的增大而明显升高；非白色念珠菌是胃液培养的主要真菌，其耐药率高于白色念珠菌，数量增加提示患者预后较差。
Objective To investigate the direct relationship and significance between the pH value of gastric juice and positive fungi in culture critical patients with artificial airway in intensive care unit （ICU） by analyzing and identifying the type of fungi and their sensitivity to antifungal therapy. Methods A prospective study was conducted. One hundred and sixty patients （between December, 2008 and October, 2011 ） with artificial airway lasting longer than 48 hours were studied in the ICU at the First Affiliated Hospital of Shenzhen University. The gastric juice specimens were collected through a nasogastric tube, their pH values were measured using precise litmus paper. These samples were divided into six groups according to their pH values： pHi2.0, pH 2.1-3.0, pH 3.1-4.0, pH 4.1-5.0, pH 5.1-6.0 and pH 6.1-7.0, and then fungi were cultured in these specimens with different pH values. Susceptibility of different fungicide drugs were also investigated. The susceptibility of fungi to gastric juice with different pH values was also investigated. The relationship between 28-flay survival rate and the presence of fungi in gastric juice was analyzed in order to analyze the relationship of the presence of fungi in gastric juice and clinical outcome. Results ① No fungal growth was found in the gastric juice with pH value lower than 4.0, and the positive rate of fungal culture was significantly increased when the pH value of gastric juice raised. ② The positive rate of fungal growth was 27.9% （55/197）, in which, the positive rate of Candida and non-Candida fungi was 38.2% （21/55） and 61.8% （34/55） respectively, and the difference was significant statistically （ X 2 = 4.16, P〈0.05）.③The fungal positive rate was 40.0% （22/55） and 60.0% （33/55） respectively, in survivors （102 cases） and non-survivors （58 cases）. The percentage of Candida infection and non-Candida infection was 54.5% （ 12/22 ） and 45.5% （10/22） respectively, in survivors, and it was 27.3% （9/33） and 72
出处
《中国危重病急救医学》
CAS
CSCD
北大核心
2012年第2期96-99,共4页
Chinese Critical Care Medicine
基金
广东省医学科研基金（A2010525）
关键词
人工气道
胃液真菌培养
重症患者
临床意义
Artificial airway
Culture of fungi in gastric juice
Critically ill patient
Clinical significance
