82例老年人肺部念珠菌感染的临床分析

Diagnosis and therapy of pulmonary candidial infection in the aged

目的对我院１９８０年１月至１９９５年５月收治的８２例老年人肺部念珠菌感染病例进行分析，探讨其临床特点。方法３％过氧化氢溶液漱口后采取痰标本，连续３次以上痰真菌培养为同一种菌，并结合临床确诊。６３例应用氟康唑治疗的患者中，４２例口服，第１天３００ｍｇ，第２天改为１５０ｍｇ，每天１次；另２１例患者第１天４００ｍｇ静滴，第２天改为２００ｍｇ静滴，每天１次。连续１～２周后改口服１５０ｍｇ，每天１次。疗程３～４周。应用其它抗真菌药物治疗者包括酮康唑１４例，两性霉素Ｂ１例，５－ＦＣ１例。结果６３例应用氟康唑治疗患者，病死率９．５２％。应用其它抗真菌药物者，治愈９例，死亡７例。氟康唑治疗组１２例出现轻度胃肠道反应，其它抗真菌药物组中８例出现轻、中度胃肠道反应。结论老年人肺部念珠菌感染的治疗，除停用抗生素、改善营养状况外。

Objective Clinical features of 82 cases(male 72,female 10,aged 68±5 yrs) of pulmonary candidial infections in the aged admitted to this hospital from January 1980 to May 1995 are analysed.Methods Sputum specimens were collected after rinsing out with 3% hydrogen peroxide solution,pulmonary candidial infections can be diagonesed with three consecutively positive sputum cultures and clinical manifestations.Of 63 patients treated with fluconazole,42 patients were given by oral route with the inital dose of 300mg fluconazole on the first day and then the dose of 150mg fluconazole was administered orally once a day.In the other 21 patients treated with fluconazole,a dose of 400mg was given by intravenous route on the first day and then the dose of 200mg was administered once a day in one to two weeks and after that the dose of 150mg was given orally once a day.The therapy course of fluconazole was three to four weeks.Results The mortality of pulmonary candidial infections in 63 elderly patients treated with fluconazole was 9.52%.In the group of patients treated with other antifungeal agents,including 14 cases treated with ketoconazole,one with amphotericin B and one with 5-flurocytosin,9 cases cured and 7 cases died.12 cases treated with fluconazole suffered from a few side-effects of gastrointestinal tract.In the group treated with other antifungeal agents.8 cases suffered from mild to moderate adverse reaction of gastrointestinal tract.Conclusions The treatment of pulmonary candidial infections in the aged,besides the withdrawal of antimicrobial agents and improvement of nutrition state,antifungeal agents should be early and properly applied.