卡泊芬净治疗18例肺部真菌感染临床分析.docVIP

卡泊芬净治疗18例肺部真菌感染临床分析 　【摘要】 目的 调查卡泊芬净治疗肺部真菌感染患者的疗效及安全性。方法 通过回顾性分析，了解卡泊芬净治疗呼吸科重症监护病房(RICU)中肺部真菌感染患者的疗效和不良反应。结果 18例疗效评价病例中，临床有效率为38.9%(7/18)。10例侵袭性肺曲霉病患者中，5例临床有效。9例卡泊芬净疗程大于10d者中，7例治疗有效；9例疗程小于7d的患者均治疗无效。2例首选卡泊芬净患者治疗都有效；14例将卡泊芬净作为挽救治疗者中，仅3例临床有效，其中2例为侵袭性肺曲霉病。所有纳入安全性评价的12例患者均未出现临床和实验室的不良反应。结论 卡泊芬净是治疗侵袭性肺曲霉病的安全有效药物，其作为一线抗真菌药物对患者的预后及生存率似乎更有益。 【关键词】 卡泊芬净； 侵袭性肺部真菌感染； 疗效； 安全性 ABSTRACT Objective To investigate the efficacy and safety of caspofungin on invasive pulmonary fungal infections (IPFI) in patients. Methods A retrospective analysis was employed to inrestigate caspofungin in the treatment of invasive pulmonary fungal infections in patients from respiratory intensive care unit (RICU). Results Of the 18 evaluable patients, the total effective rate of caspofungin was 38.9%. Of 10 cases of pulmonary aspergillosis, five patients achieved clinical improvement. The group of short course of treatment with caspofungin (≤7 days) was ineffective, while the group with long course (≥10 days) had clinical responses. As for first-line antifungal therapy, caspofungin demonstrated favourable effect in two cases. As for salvage treatment, the improvement rate of caspofungin was 21.4% (3/14), and 2 of 3 cases were pulmonary aspergillus infections. No drug-related clinical adverse events and laboratory adverse event occurred in 12 cases of patients receiving caspofungin. Conelusion Caspofungin was effective and safe in the treatment of invasive pulmonary aspergillosis. In the case when caspofungin was considered as first-line antifungal therapy, it could be more benifcial to survival rates and prognosis of the patients. KEY WORDS Caspofungin; Invasive pulmonary fungal infections; Clinical improvement; Security 近年来，由于免疫功能低下(抑制)人群不断增加、广谱抗生素和肾上腺糖皮质激素广泛应用甚至滥用等，深部真菌感染的发病率呈明显上升趋势。呼吸科重症监护病房(RICU)由于存在多种高危因素，患者常继发深部真菌感染，鉴于目前微生物学和免疫学检测的局限性，临床常采用经验性用药。何时开始治疗以及选用何种药物是经验性治疗成功的关键。本文通过回顾性分析，了解卡泊芬净治疗广州医学院第一附属医院RICU收治的深部真菌感染患者的疗效和安全性，探讨卡泊芬净在经验性治疗中的使用时机和指征。 1 材料和方法 1.1 病例来源 2005年10月～2006年10月广州医学院第一附属医院英