卡泊芬净治疗心脏术后侵袭性真菌病20例临床分析

Efficacy and safety of caspofungin for treatment of invasive fungal infection in 20 patients after cardiac surgery

目的:探讨卡泊芬净治疗心脏术后并发侵袭性真菌感染(IFI)的疗效与安全性。方法:回顾分析我院呼吸科、心外科和急诊重症监护室(ICU),接受过卡泊芬净治疗的心脏术后合并IFI患者临床资料。结果:2005年5月至2010年12月,共有20例接受了卡泊芬净治疗。男性12例,女性8例,中位年龄65岁(23～82)岁。确诊10例,皆为念珠菌血症(白念珠菌4例,近平滑念珠菌3例,光滑念珠菌、热带念珠菌和克柔念珠菌各1例);临床诊断肺IFI 5例(念珠菌3例,曲霉2例);拟诊肺IFI 5例,病原真菌不明。冠状动脉搭桥(CABG)术8例,瓣膜手术8例,胸主动脉瘤手术2例,先天性心脏病(先心病)和马方综合征手术各1例。卡泊芬净的使用时间中位数为18(1～55)d。1例于用药当天死于心脏骤停疗效无法判断,19例可评估患者中,痊愈10例(10/19,52.6%),显效4例(4/19,21.1%),总有效率为73.7%,进步3例,无效2例。死亡6例(6/20,病死率30.0%)。治疗过程中未发现与卡泊芬净有关的不良反应。结论:卡泊芬净是治疗心脏术后并发IFI的有效安全药物,值得进一步临床验证。

Objective：To evaluate the efficacy and safety of caspofungin for treatment of invasive fungal infection（IFI） in post cardiac surgery patients.Methods：A retrospective analysis of the clinical data of patients who were diagnosed with IFI and treated with caspofungin in 3 ICUs（respiratory,surgical and emergency respectively） of our hospital was performed.Results：From May 2005 to December 2010,20 patients with IFI were treated with caspfungin,male 12,female 8,median age 65（range 23-82） years old.Ten were proven cases,all were diagnosed as candidemias（4 C.albicans,3 C.parapsilosis,1 C.glabrata,1 C.Tropicalis and 1 C.Krusei）,5 probable pulmonary IFI cases（3 C.albicans and 2 aspergillus species） and 5 possible pulmonary IFI（pathogens unknown）.Among the 20 patients,8 Coronary artery bypass graft surgeries,8 valve replacements,2 aortic aneurysm surgeries,1 Congenital heart disease surgery and 1 Marfan syndrome surgery.The median duration of the caspofungin therapy was 18（range 1-55） days.Among the 19 evaluable patients（1 died of cardiac arrest at day 1 of the therapy and was excluded）,10 were cured（10/19,52.6%）,4 were markedly improved（4/19,21.1%）,with an overall effective rate of 73.7%（14/19）,3 were improved and 2 failed,6 died（death rate,6/20,30.0%）.No drug-associated side effect or toxicity was recorded.Conclusion： Caspfungin is likely to be an effective and safe drug to treat IFI in post cardiac surgery patients,and warrants further clinical study.