10例肝衰竭合并侵袭性真菌感染患者的临床分析

Analysis of 10 cases with liver failure complicated by invasive fungal infections

目的探讨肝衰竭合并侵袭性真菌感染(IFI)的诱因、诊断及治疗。方法对10例肝衰竭合并IFI的患者临床资料进行回顾性分析。结果10例IFI患者的感染部位:消化道占50%,呼吸道占33.3%,其它血液、腹腔各占8.3%。感染菌种主要为白色念珠菌(50%),其它热带念珠菌、光滑念珠菌及曲霉菌各占16.6%。本组病例IFI发病前80%的病例曾接受侵入性操作,全部患者有2种抗菌素用药史且疗程超过1周。10例IFI患者均接受抗真菌治疗,真菌感染治愈1例,好转2例,未愈7例,终因肝衰竭死亡8例。结论肝衰竭合并IFI病死率高、预后差。积极避免诱发因素,注重早预防、早诊断和及时治疗是降低这类患者病死率的重要环节。

Objective To study risk factor,diagnosis and therapy in patients with liver failure complicated by invasive fungal infections（IFI）.Methods Ten patients with liver failure complicated by IFI was studied retrospectively.Results IFI of digestive tract accounted for 50%,that of respiratory tract,blood and abdominal cavity accounted for 33.3%,8.3%,8.3%,respectively.Candida albicans accounted for 50%,Candida tropicals,Candida glabrata and aspergillus accounted for 16.6%,individually.Use of broad-spectrum antibiotic and improper medical manipulations were significant risk factors.All of 10 cases received anti-fungal therapies and showed that 1 case cured and 2 alleviated.The mortality due to liver failure and IFI was 80%.Conclusions Risk factors of liver failure complicated by IFI should be avoided.Early prophylaxis,early diagnosis and appropriate therapy would be important for these patients.