瓣膜置换术后真菌感染18例临床分析

Clinical Anlysis on 18 Cases of Mycotic Infection after Heart Valve Replacement

目的分析和总结体外循环心脏瓣膜置换手术后合并真菌感染的临床特点及耐药情况。方法对46例体外循环心脏瓣膜置换术后18例继发真菌感染的临床资料进行统计分析,分析术后培养分离出的23株感染真菌的药敏试验结果。结果术前长期吸烟或支气管炎,心脏瓣膜置换术体外循环时间长,术后长期使用广谱抗生素、机械通气、全肠外营养及侵入性检查治疗等均是真菌感染高危因素。瓣膜置换术后真菌感染部位以呼吸道为主,其次为血液、静脉导管顶端,继之为泌尿系。目前治疗真菌感染的药物主要有咪唑类和多烯类,前者包括氟康唑、伊曲康唑,后者包括制霉菌素、两性霉素B、5-胞嘧啶。结论合理使用广谱抗生素和糖皮质激素,尽量减少不必要的侵入性操作,加强全身营养及脏器功能支持,改善肠道微生态平衡,密切监测真菌感染的一切临床迹象,注重预防及经验性治疗;治疗上应选择敏感、毒副作用轻的抗真菌药物。

Objective To analyze and sum up the clinical characteristic and drug-fast situation of mycotic infection after heart valve replacement with extracorporeal circuIation.Methods 18 out 46 cases of heart valve replacement with extracorporeal circulation had mycotic infection.their clinical data were statistically analyzed.The results of drug sensitive test of 23 strain of infection mycotic detach after operation were also analyzed.Results High-risk factor leading to mycotic infection includs：chronic smoking or bronchitis,long time of extracorporeal circulation during heart valve replacement,chronic application of wide-spectrum antibiotic after operation,mechanical ventilation,full parenteral alimentation and invasive checking therapy,etc.mycotic infection portion after heart valve replacement mainly occurr in respiratory passage,then blood,top of ductus venosus,urinary system as follow.Medicine that cure mycotic infection today can be divided into two kind： imidazole group and polyene group.imidazole group includs： fluconazol and Itraconazole;polyene group includes： nystatin,amphotericin B and 5-cytimidine.Conclusion To prevent mycotic infection,we should rationally use wide-spectrum antibiotic and glucocorticoid,reduce unnecessary invasive operation as possible,intensify nutrition and organ function upholding,improve intestinal ecidioclimate balance,closely monitor every clinical symptom of mycoic infection,pay attention to preventive and experience therapy.As for medicine,we should use the anti-mycotic-infection medicine which is sensitive,with less toxic and side-effect.