两性霉素B肾功能衰竭透析患者中的应用评估

Safety ofAmphotericin B in ESRD Patients with Fungal Infections

目的:观察两性霉素B在肾衰竭透析并深部真菌感染患者中的不良反应。方法:回顾性分析15例肾功能衰竭透析并真菌感染患者应用两性霉素B的不良反应。结果:男8例,女7例;年龄64～84岁,平均(78.1±5.6)岁,不良反应发生率为66.7%(10/15),包括低钾血症、肝功能受损、寒战发热、静脉栓塞,以肝功能损害最为多见,其发生率为33.3%。使用两性霉素B前、后残余肾功能[前(10.58±3.75),后(8.92±2.86)ml/Min]、收缩压[前(147.7±15.6),后:(131.4±17.12)mmHg]有差异(P<0.05),余尿量[前(734±472),后(701±515)ml/24h]、心率[前(77.5±5.48),后(7 8. 4±5.6)次/分]、舒张压[前(91.2±13.2),后(86.8±10.1)mmHg]没有差别(P>0.05)。结论:两性霉素B在肾功能衰竭患者最常见的不良反应是肝功能异常,治疗前后对残余肾功能有影响,不良反应通过治疗多能恢复,使用安全有效。

Objective： Amphotericin B is used commonly to treat fungal infections. Negative effects exist regarding the use of intravenous amphotericin B in patients with end-stage renal disease （ESRD）.The article is used to judge the advantages and disadvantages of Amphotericin B. Methods：We retrospectively reviewed the clinical course of patients receiving amphotericin B. Fifteen episodes of systemic fungal infection occurring in 15 patients with ESRD treated with parenteral amphotericin B administered were noted. Patients received a maintenance dose of 0.5 to 0.7 mg/kg amphotericin B intravenously daily. Every patients received （1.04±0.81g） of amphotericin B average, whereas 1 patient with meningitis received a total of 3.13g. Results： Incidence of negative effect was 66.7%, two patients exhibited a temperature rise greater 1.6 degree C after drug infusion compared with before drug infusion, five patients exhibited a abnormality of liver function,ten patients （include the patient with meningitis） resolved their respective fungal infections. Systolic pressure and remain Ccr were decreased compared with treatment of amphotericin B before and after.Increases in heart rate, as well as decrease of diastolic pressure and 24h urine amount did not change significantly before and after therapy. Conclusion：Administration of amphotericin B in ESRD patients with fungal infections was generally well tolerated. Our observations suggest that amphotericin B is effective and safe for outpatient dialytic patients when administered according to protocol.