伏立康唑治疗重症患者侵袭性真菌感染的回顾性分析

Retrospective Analysis of Voriconazole in the Treatment of Invasive Fungal Infections in Critically Ill Patients

目的:评价某"三甲"医院伏立康唑在重症患者侵袭性真菌感染(IFI)中使用的有效性、安全性。方法:回顾性调查该"三甲"医院2012年7月-2013年6月住院重症患者使用伏立康唑的情况,以患者基本信息、感染类型、细菌培养结果、给药方案及使用时间、合并用药等作为考察指标进行相关分析。结果:使用伏立康唑的173例患者中,123例(71.1%)有效,22例患者存在不同程度肝功能不全,其中14例治疗有效;60.1%的患者(104/173)在用药前有相关微生物学检查结果,其中63.5%的患者(66/104)为曲霉菌半乳甘露聚糖抗原检测(GM试验)阳性,27.9%的患者(29/104)为真菌培养阳性,微生物检查结果阳性组治疗有效率为80.8%,阴性组有效率为56.5%,两组比较差异有统计学意义(P<0.05);有3例发生不良反应,其中1例为联用环孢素后因血药浓度升高而导致调整给药方案。结论:伏立康唑能安全、有效地治疗重症患者的侵袭性真菌感染,但仍应密切关注患者肝肾功能、药物间相互作用及血常规的监测,以减少不良反应的发生,减缓耐药性的产生,减轻患者经济负担。

OBJECTIVE： To evaluate the efficacy and safety of application of voriconazole in the critically ill patients with invasive fungal infections （IFI） in a third grade class A hospital. METHODS： A retrospective study was performed on the application of voriconazole in a third grade class A hospital from Jul. 2012 to Jun. 2013. The observed factors, including patient＇s general information, type of infection, results of microbiological cultures, dosage regimen and duration of therapy and drug combination, were analyzed. RESULTS： Among included 173 cases, effective treatment was observed in 123 cases （71.1%）. There were 22 patients with hepatic dysfunction, including 14 cases of effective treatment. 60.1% patients （104/173） received relevant microbiological ex- amination before treatment, including 63.5% （66/104） cases of GM test positive and 27.9% （29/104） cases of positive fungal cul- ture. The effective rate of positive group was 80.8% and that of negative group was 56.5% ; there was statistical significance （P〈 0.05）. There were 3 cases of ADR, including dosage regimen of a case was adjusted due to the increase of plasma concentratio af- ter receiving cyclosporine. CONCLUSIONS ： Voriconazole is safe and effective in the treatment of invasive fungal infection. Greact importance should be attached to liver and kidney fimction of patients, drug interactions and blood testing to reduce the incidence of adverse reaction, slow down the incidence of drug resistance and reduce financial burden of patientso