危重症患者并发深部真菌感染的早期治疗

目的 探讨在危重症病房患者并发深部真菌感染进行早期抗真菌治疗的适应证以及治疗效果.方法 对60例患者进行真菌病原学检测,同时进行早期经验性治疗,首选大扶康,200 mg每12小时1次,静脉滴注,对大扶康无效或根据病原学改用二性霉素B治疗.结果 60例真菌感染患者,其中白色念珠菌念珠最多占42例(70.00%),感染部位肺部最多占39例(65.00%),两种以上真菌感染及两个以上部位感染的患者分别为4例(6.67%)和5例(8.33%).大扶康的有效率为60.00%,大扶康无效者对二性霉素B有效率为41.67%,总的有效率76.67%,无效率8.33%,死亡率15.00%.结论 对急危重症的患者,真菌感染的早期治疗是关键,大扶康对大多数患者有效,需早期用药.

Early treatment of deep mycosis for critically ill patients in central intensive care unit

Objective To explore the indication and the validity of early treatment to deep mycosis for critically ill patients in ICU.Methods Sixty patients possibly contracted deep mycosis were checked germs and performed early empirically treatment.We first chose Fluconazole 200mg by the way of venous drop every 12 hour.Amphotericin B was alternative to Fluconazole if the drug sensitive tests were supported or Fluconazole had no effect on fungal infection.Results Sixty patients were diagnosed as deep mycosis,among which 42 cases(70%)were Candida albicans in fungal spectrum and the lungs of 39 cases(65%) were found infected.4 patients had more than 2 germs of fungus.And five patients had two infected area.Among these sixty patients.60% percent had response to Fluconazole and 41.6% had no response to Fluconazole,but proved responsive to Amphotericin B.Total effectiveness rate,no response rate and mortality rate were 76.67 %,8.33 % and 15 % respectively.Conclusion The use of extensive-spectrum antibiotic and glucocorticoid increased the risk of fungal infection.Early treatment to deep mycosis for critically ill patients in central intensive unit was critical.Most patients had response to Fluconazole,but the drug regulation must be performed early.