注射用两性霉素B治疗艾滋病/HIV感染合并深部真菌感染的不良反应及防护

Prevention of the Adverse Drug Reactions Induced by Amphotericin B for Injection in Patients with HIV/AIDS Accompanied with Deep Fungal Infection

目的:为临床合理应用注射用两性霉素B(AMB)治疗人类免疫缺陷病毒(HIV)感染或艾滋病(AIDS)合并深部真菌感染提供参考。方法:收集某院2010年1月至2012年2月期间住院治疗的3 202例HIV/AIDS患者的临床资料,分析其中使用AMB治疗深部真菌感染患者的不良反应(ADR)发生及防护。结果:HIV/AIDS合并深部真菌感染患者948例,感染率为29.61%;899例使用AMB,其中18例出现ADR,发生率为2.00%。AMB静脉滴注的ADR主要表现为发热、腹泻、瘙痒、肝功能异常及血液系统毒性。及时停药或减量,同时对症治疗,可有效地减少、减轻药物的ADR。结论:AMB虽ADR多见,但其疗效确切,是治疗HIV/AIDS合并深部真菌感染比较安全、有效、经济的选择。只要合理用药,严密监测用药后患者病情进展,尽早发现ADR,及时采取有效措施,并将心理护理贯穿治疗始终,就能保证患者治疗的顺利进行。

OBJECTIVE：To provide reference for clinical rational use of Amphotericin B for injection in the treatment of patients with HIV/AIDS accompanied with deep fungal infection. METHODS：The clinical data of 3 202 patients with HIV/AIDS hospitalized in our hospital from Jan. 2010 to Feb. 2012 were collected;the occurrence and the prevention of the adverse drug reactions（ADR）in those patients with accompanied deep fungal infection were analyzed. RESULTS：948 patients（29.61%）had accompanied deep fungal infection and 899 patients received Amphotericin B for injection,with 18（2.00%）presented with ADR that manifested mainly as fe-ver,diarrhea,pruritus,abnormal liver function and blood system toxicity,yet the ADR were reduced in incidence or alleviated after timely drug withdrawal and symptomatic treatment. CONCLUSIONS：Although with frequent ADR presence,Amphotericin B for in-jection has proved efficacy and it serves as a safe,effective and economical choice in the treatment of HIV/AIDS accompanied with deep fungal infections. Treatment process can go smoothly as long as with rational use of drugs,close monitoring of disease progression after medication,early detection of ADR and timely and effective countermeasures as well as psychological care throughout the treat-ment course.