PICU深部真菌感染分析与治疗

Analysis and treatment of invasive fungal infection in PICU

目的探讨儿童重症监护室（PICU）深部真菌感染的发生特点、病原学种类及治疗情况,提高诊治水平。方法选取2009年1月~2011年6月PICU住院确诊为深部真菌感染的19例儿童为研究对象,回顾性分析其真菌感染的易感因素、病原学特点及抗真菌治疗效果。结果患儿基础疾病以肺部疾病最多见,占57.9%（11例）。易感因素有侵入性操作（19/19）,使用广谱抗生素≥4d（19/19）,应用静脉营养（10/19）和应用呼吸机（9/19）。致病菌以白色念珠菌多见,占84.21%（16例）,热带念珠菌2例,新型隐球菌1例。19例均给予抗真菌治疗。8例单用氟康唑（Flu）,其余11例用二性霉素B脂质体（L-AMB）联合氟康唑（Flu）治疗。13例治愈,4例好转,2例死亡。结论 PICU儿童深部真菌感染与多种易感因素有关,白色念珠菌是儿童深部真菌感染的常见病原,氟康唑（Flu）单用,或氟康唑（Flu）联合二性霉素B脂质体（L-AMB）是治疗儿童深部真菌感染的有效治疗方案。

Objective To explore the clinical characteristics, fungal species and the treatment of deep fungal infection in PICU, and to enhance the level of diagnosis and treatment. Methods Nineteen children with deep fungal infection hospital- ized in PICU from January 2009 to June 2011 were selected as object of study, predisposeng factors, pathogenic character- istics and treatment efficacy of fungal infection were retrospectively analyzed. Results The most common basal illness was lung disease, accounted for 57.9% （11 cases）. There were some predisposing factors such as invasive operation （19/19）, us- ing of broad-spectrum antibiotics for more than 4 days （19/19）, intravenous nutrition （10/19） and mechanical ventilation （9/19）. The most pathogenic bacterium was candida albicans, accounted for 84.21% （16 cases）, 2 cases of candida tropicalis, 1 case of cryptococcus neoformans. 19 cases were treated with antifungal therapy. Fluroconazole（Flu）was used alone in 8 cases, Liposome Amphotericin （L-AMB） combined with Fluroconazole were used in 11 cases. 13 cases were cured, 4 cases were relieved and 2 cases were died. Conclusion Children invasive fungal infection relatives to lots of predisposing factors in PICU, the most pathogenic bacterium is candida albicans. Flu or L-AMB combined with flu is effective therapeutic schedule in the treatment of invasive fungal infection of children.