卡泊芬净治疗心脏术后侵袭性真菌病20例临床分析

目的:探讨卡泊芬净治疗心脏术后并发侵袭性真菌感染(IFI)的疗效与安全性。方法:回顾分析我院呼吸科、心外科和急诊重症监护室(ICU),接受过卡泊芬净治疗的心脏术后合并IFI患者临床资料。结果:2005年5月至2010年12月,共有20例接受了卡泊芬净治疗。男性12例,女性8例,中位年龄65岁(23～82)岁。确诊10例,皆为念珠菌血症(白念珠菌4例,近平滑念珠菌3例,光滑念珠菌、热带念珠菌和克柔念珠菌各1例);临床诊断肺IFI 5例(念珠菌3例,曲霉2例);拟诊肺IFI 5例,病原真菌不明。冠状动脉搭桥(CABG)术8例,瓣膜手术8例,胸主动脉瘤手术2例,先天性心脏病(先心病)和马方综合征手术各1例。卡泊芬净的使用时间中位数为18(1～55)d。1例于用药当天死于心脏骤停疗效无法判断,19例可评估患者中,痊愈10例(10/19,52.6%),显效4例(4/19,21.1%),总有效率为73.7%,进步3例,无效2例。死亡6例(6/20,病死率30.0%)。治疗过程中未发现与卡泊芬净有关的不良反应。结论:卡泊芬净是治疗心脏术后并发IFI的有效安全药物,值得进一步临床验证。

Efficacy and safety of caspofungin for treatment of invasive fungal infection in 20 patients after cardiac surgery

Objective:To evaluate the efficacy and safety of caspofungin for treatment of invasive fungal infection(IFI) in post cardiac surgery patients.Methods:A retrospective analysis of the clinical data of patients who were diagnosed with IFI and treated with caspofungin in 3 ICUs(respiratory,surgical and emergency respectively) of our hospital was performed.Results:From May 2005 to December 2010,20 patients with IFI were treated with caspfungin,male 12,female 8,median age 65(range 23-82) years old.Ten were proven cases,all were diagnosed as candidemias(4 C.albicans,3 C.parapsilosis,1 C.glabrata,1 C.Tropicalis and 1 C.Krusei),5 probable pulmonary IFI cases(3 C.albicans and 2 aspergillus species) and 5 possible pulmonary IFI(pathogens unknown).Among the 20 patients,8 Coronary artery bypass graft surgeries,8 valve replacements,2 aortic aneurysm surgeries,1 Congenital heart disease surgery and 1 Marfan syndrome surgery.The median duration of the caspofungin therapy was 18(range 1-55) days.Among the 19 evaluable patients(1 died of cardiac arrest at day 1 of the therapy and was excluded),10 were cured(10/19,52.6%),4 were markedly improved(4/19,21.1%),with an overall effective rate of 73.7%(14/19),3 were improved and 2 failed,6 died(death rate,6/20,30.0%).No drug-associated side effect or toxicity was recorded.Conclusion: Caspfungin is likely to be an effective and safe drug to treat IFI in post cardiac surgery patients,and warrants further clinical study.