外耳道真菌病患者的真菌分布与治疗效果观察

Distribution of fungi in patients with otomycosis extema and therapeutic effect

目的了解外耳道真菌病患者的真菌谱检测及其治疗效果,为临床治疗提供参考依据。方法 2010年7月-2014年6月对114例外耳道真菌病患者的外耳道痂块、苔皮标本进行病原菌检测和药敏试验,给予合理的抗真菌药物治疗,治疗后评价治疗效果,数据采用SPSS 20.0软件进行统计分析。结果共确诊真菌感染114例、148耳,其中病变位于左耳41例、右耳39例、双耳34例;最常见的病史为耵聍潴留占39.86%、耳道解剖异常占27.70%和外耳道异物占20.27%;患者送检标本中检出156株真菌,以曲霉菌属为主占70.51%;曲霉菌属、假丝酵母菌属对氟康唑、氟胞嘧啶均无耐药菌株检出;而对酮康唑、伊曲康唑和伏立康唑的耐药率均较低;治疗两个疗程后治愈96耳,治愈率64.86%,总有效率为95.27%。结论在外耳道真菌的治疗中,应根据真菌药敏试验结果选择合理抗真菌药物,才能获得良好的治疗效果。

OBJECTIVE To understand the fungal spectrum of the patients with otomycosis extema and observe the therapeutic effect so as to provide guidance for clinical treatment .METHODS From Jul 2010 to Jun 2014 ,totally 114 patients with otomycosis extema were enrolled in the study ,then the external auditory canal scabs ,moss spec‐imens were cultured for pathogens ,the drug susceptibility testing was performed ,the antifungal agents were rea‐sonably used ,the therapeutic effect was evaluated ,and the statistical analysis of the data was performed with the use of SPSS 20 .0 software .RESULTS A total of 148 ears were confirmed as the fungal infections ,including 41 ca‐ses with lesions in left ears ,39 cases with lesion in rights ears ,and 34 cases with lesions in both ears .Among the most common disease histories ,39 .86% had the cerumen retention ,27 .70% had the ear canal anatomic abnor‐malities ,and 20 .27% had the external auditory canal foreign body .Totally 156 strains of fungi were isolated from the submitted specimens ,of which 70 .51% were Aspergillus;none of Aspergillus or Candida that was resistant to fluconazole or flucytosine was detected ,while the drug resistance rates to ketoconazole ,itraconazole ,and vori‐conazole were relatively low .Totally 96 ears were cured after two treatment courses ,with the cure rate of 64 .86%and the total effective rate of 95 .27% .CONCLUSION As for the treatment of otomycosis extema ,it is necessary to reasonably use the antifungal agents on the basis of the results of drug susceptibility testing so as to achieve good therapeutic effect .