47例深部真菌感染的诊疗经验

Treatment of 47 cases of invasive fungai infection

目的：通过47例深部真菌感染病例的临床分析,总结该类疾病的特点、诊疗难点和经验。方法：统计整理全组病例的原发病、感染真菌的类型和疗效、总结其经验。结果：本组深部真菌感染中,中老年人占多数(89．4%),且绝大多数(93．61%)以继发性感染的形式出现。真菌菌型分布,白色念株菌仍占主导地位(78．7%)。治疗的关键除得力的抗真菌外,与原发病的治疗密切相关。结论：深部真菌感染的发生与原发病治疗的失当和病人的体弱、免疫力下降有关。治疗上要标本兼顾,尤其对原发病的及时有效治疗起重要作用。原发病类型与真菌感染的种类没有相关性,分布较散,但是要注意八种真菌易感情况。二性霉素B能否在合并肾功能障碍病人中应用要视病因而定：若肾功能障碍主要是由真菌性脓毒症引起的或者说真菌感染是发生肾衰的重要原因之一,可以在监测下有控制使用；如若肾衰与真菌感染无关,则不用为妥。

Objective:To investigate the characteristic,diagnosis and therapy of invasive fungal infections. Methods:Retrospective analysis of recent clinical data of 47 cases of invasive fungal infections in our ICU was per- formed,including primary diseases,specific pathogens,essential managements,and treatment result.Results:A- mong these patients,89.4% of them were elderly individuals,and 93.6 of them were secondary infection.Candida albicans remained the most common pathogens(78.7%)in these patients.In addition to appropriate antifungal treatment,proper management of the primary diseases was also very important to obtain satisfactory outcomes from these infections.Conclusion:The occurrence of invasive fungal infections is usually due to unsuccessful treat- ment of the primary diseases,patients' poor general condition with suppression of immune functions.Therapeutic strategies include elimination of all the risk factors and timely and efficient treatment of the primary diseases.Am- photericin B might he a optimal in spite of to renal dysfunction if it is the result of invasive fungal infection.Other- wise amphotericin B should be avoided in patients with renal dysfunction.