糖尿病酮症酸中毒并侵袭性肺曲霉病1例

摘要：目的 为糖尿病酮症酸中毒合并侵袭性肺曲霉病的抗感染治疗提供参考。方法 临床药师参与1例糖尿病酮症酸中毒合并侵袭性肺曲霉病感染治疗的过程，通过查阅文献分析前期单药治疗效果不佳的原因，协助医师调整治疗方案，建议多药联合治疗，并对患者实施全程药学监护。结果 患者积极补液降糖后，酮症和血糖被迅速纠正，同时医师采纳药师建议，予以伏立康唑联合卡泊芬净、辅以两性霉素B雾化吸入，患者肺部感染得到有效控制。出院伏立康唑序贯一月后复查肺CT较前明显吸收。在药师的监护与随访下，患者未出现药物不良反应。结论 糖尿病酮症并侵袭性肺曲霉病，感染较重，宜考虑三唑与棘白菌素的联合、辅助两性霉素B雾化来提高治疗的成功率。

Diabetic ketoacidosis with invasive pulmonary aspergillosis: A case report

Abstract Objective To provide a reference for the treatment of diabetic ketoacidosis with invasive pulmonaryaspergillosis. Methods The clinical pharmacist participated in the treatment of a diabetic ketoacidosis patient withinvasive pulmonary aspergillosis infection. By reviewing the literature and analyzing the reasons for the poor outcomeof previous mono-drug therapy, the treatment plan was adjusted to multi-drug therapy. Pharmaceutical care for thepatient was also provided by the pharmacist. Results The patient's ketoacidosis and high blood sugar level werequickly corrected with fluid infusion and insulin therapy. Voriconazole combined with caspofungin, together withamphotericin B nebulized inhalation were used as the antifungal therapy, and pulmonary infection of the patient waseffectively controlled. The patient was prescribed with oral voriconazole upon discharge. Chest CT was performedone month after discharge and showed obvious absorption and improvement. No adverse drug reactions occurred withfollow-ups by the pharmacist. Conclusion Diabetic ketoacidosis with invasive pulmonary aspergillosis is a lifethreateninginfection. Combination therapy with intravenous triazole and echinocandins as well as amphotericin Bnebulized inhalation may be useful to achieve a better pharmacotherapy outcome.