【摘要】 目的 探討老年慢性阻塞性肺疾病(COPD)患者院內(nèi)肺部真菌感染的可能易患因素、感染時(shí)間、臨床特征、感染常見真菌與預(yù)后。 方法 回顧性分析36例65歲以上COPD 院內(nèi)肺部真菌感染患者與同期40例65歲以上COPD院內(nèi)肺部非真菌感染患者的臨床資料。 結(jié)果 老年COPD患者院內(nèi)肺部真菌感染的可能易患因素與長(zhǎng)期使用廣譜抗生素、糖皮質(zhì)激素,低蛋白血癥、粒細(xì)胞減少相關(guān);吸煙時(shí)間較長(zhǎng)及每年住院次數(shù)增多也是老年COPD患者發(fā)生院內(nèi)肺部真菌感染的可能易感因素;約1/3患者肺部真菌發(fā)生在入院1~2周,臨床特征無(wú)特異性;病原菌主要為白色念珠菌(8055%),胸部X線表現(xiàn)以支氣管肺炎及團(tuán)塊影改變?yōu)橹?預(yù)后較差。 結(jié)論 老年COPD患者若長(zhǎng)期使用廣譜抗生素和(或)糖皮質(zhì)激素,有低蛋白血癥或粒細(xì)胞減少,可能會(huì)并發(fā)院內(nèi)肺部真菌感染,預(yù)后較差,長(zhǎng)期吸煙及多次住院患者也應(yīng)提高警惕,重視可能易患因素并盡早采取預(yù)防與治療措施,減少死亡的發(fā)生?！続bstract】 Objective To investigate the possible risk factors of nosocomial pulmonary fungal infection, infection time, the clinical features, common infection fungal and prognosis of elderly patients with chronic obstructive pulmonary disease (COPD). Methods The clinical data of 36 patient of COPD complicated with nosocomial pulmonary fungal infection over 65 years old and 40 patients without nosocomial pulmonary fungal infection were retrospectively analyzed. Results Longterm use of broadspectrum antibiotics and (or) glucocorticoid, hypoalbuminemia, neutropenia, smoking for a long time, and hospitalizations were risk factors for nosocomial pulmonary fungal infection in elderly COPD patients. In about 1/3 of patients, nosocomial pulmonary fungal infection occurred within one to two weeks of hospitalization. The clinical features were nonspecific. Pathogens were mainly Candida albicans (8055%). Bronchial pneumonia and group block were the main findings in Chest Xray. The prognosis was poor. Conclusion Elderly patients with COPD are prone to nosocomial pulmonary fungal infection if they have hypoproteinemia, neutropenia or use longterm broadspectrum antibiotics and (or) glucocorticoids.