两性霉素B经支气管镜肺部局部注入的理论依据和操作流程

The theoretical basis and operational procedure of local instillation of amphotericin B into lungs by bronchoscopy

肺部真菌感染播散迅速,需药物及时干预。短期内即可形成组织坏死及肺局部结构性毁损,经有效抗真菌药物控制或经患者自身免疫局限后,可迅速形成纤维及肉芽组织包裹。两性霉素B是多烯类抗真菌药,抗真菌谱广且作用较强。经静脉应用时,常用治疗量在肺部所达到的药物浓度对真菌仅具有抑菌作用,毒性大,不良反应多见;经气道黏膜吸收少而缓慢,刺激性不强。根据这些特点,两性霉素B经支气管镜肺部局部注入具有较大优势,值得临床推广。本文根据指南及临床实际应用经验,就两性霉素B经支气管镜肺部局部注入的理论依据和操作流程做详细说明,其中包括两性霉素B的药理机制、局部应用剂量和溶液浓度以及具体操作方法。

Pulmonary fungal infections spread rapidly and need timely intervention of medication.Tissue necrosis and local pulmonary structural damage occur in a short period of time.If fungal infections are controlled by effective antifungal drugs or limited by the patient′s autoimmune system,fibrous connective tissue and granulation tissue can be formed quickly.Amphotericin B is a polyene antifungal agent with a wide antifungal spectrum and strong effect.When intravenously applied,the concentration of amphotericin B commonly attained in lungs has only bacteriostatic effect on fungus,with high toxicity and adverse reactions.The absorption through the airway mucosa is low and slow and the irritation is not strong.According to these characteristics,local injection of amphotericin B via bronchoscopy has a great advantage,which is worthy of clinical promotion.Based on the guidelines and clinical experience,the theoretical basis and operation procedure of local instillation of amphotericin B into lungs by bronchoscopy are described in detail,including pharmacological mechanism,local dose,solution concentration and the detailed method of operation of it.