老年AECOPD患者口腔真菌感染早期干预的时机与疗效

The clinical efficacy of early application of fluconazole combined sodium bicarbonate in oral fungal infections in elderly patients with AECOPD

目的探讨早期应用氟康唑口服联合碳酸氢钠液漱口治疗老年慢性阻塞性肺疾病急性加重期(AECOPD)患者口腔真菌感染的疗效。方法纳入2018年7月1日至2019年12月31日于本院急诊病房治疗的360例老年AECOPD患者。观察患者的口腔黏膜病变情况,一旦出现真菌感染体征立即予口腔黏膜真菌涂片及痰培养,同时氟康唑口服联合2.5%碳酸氢钠漱口,观察口腔真菌感染易感因素与疗效。结果老年AECOPD合并口腔真菌感染住院患者占8.3%;与无真菌感染患者比较,真菌感染组合并糖尿病、应用激素、联合应用抗生素均高;口腔真菌涂片发现假丝酵母菌属感染占83.2%;早期发现并应用氟康唑联合碳酸氢钠漱口的老年AECOPD患者口腔真菌感染疗效显著,有效率100%,治愈率83.3%,平均治疗时间为(5.0±0.3)d;治疗后未发现肝肾功能损害;虽然真菌感染组患者较重,但早期应用抗真菌治疗后,患者病情加重比率、住院天数及住院费均无增加。结论早期氟康唑口服联合碳酸氢钠漱口治疗对老年AECOPD患者口腔真菌感染疗效显著。

Objective To investigate the efficacy of the combined application of fluconazole and sodium bicarbonate in treatment of oral fungal infections among elderly patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods A total of 360 elderly patients with AECOPD treated in the Emergency Ward of our hospital during July 1,2018 and December 31,2019,were included for observation.After admission,the oral mucosal lesions were observed every day,and fungal smear and fungal culture were performed immediately once signs of fungal infection appeared.Meanwhile,fluconazole was given with 300 mg.oral.qd.,followed by 150 mg.oral.qd.,and 2.5%sodium bicarbonate was given three times a day as gargle.Results The prevalence of oral fungal infection was 8.3%among which candida infection accounted for 83.2%.The mean treatment time was 5.0±0.3 days.Daily observation of the oral cavity,early detection and application of fluconazole combined with sodium bicarbonate had significantly clinical effect in elderly AECOPD patients with oral fungal infection,with an effective rate of 16.7%,and a cure rate of 83.3%.No toxic side effects on liver and kidney function were found during the treatment.Obvious efficacy was found in relieving clinical symptoms,and there was no increase in hospitalization costs and time.Conclusion Early combination of fluconazole and sodium bicarbonate has a significant clinical effect on control of oral fungal infection in elderly patients with AECOPD.