米卡芬净联合连续性肾脏替代治疗脓毒症伴真菌感染患者的临床结局探究

Effect of micafungin combined with CRRT on the clinical outcomes of patients with sepsis and fungal infection

目的:探讨米卡芬净联合连续性肾脏替代治疗(CRRT)对脓毒症伴真菌感染患者临床结局的影响。方法:选取116例脓毒症伴真菌感染患者为研究对象,按照治疗方法不同分为观察组和对照组,每组各58例。观察组予以米卡芬净联合CRRT治疗;对照组予以氟康唑联合CRRT治疗。对比两组患者治疗前、治疗后3 d和7 d急性生理学及慢性健康状况评分系统II(APACHEII)评分和白细胞(WBC)、中性粒细胞、C反应蛋白(CRP)、降钙素原(PCT)水平,并统计其器官衰竭情况和生存结局。结果:治疗前、治疗3 d和7 d后,两组患者APACHEII评分比较,差异均无统计学意义(P>0.05)。治疗前及治疗3 d后,观察组患者的WBC、中性粒细胞水平及CRP、PCT水平与对照组比较,差异均无统计学意义(P>0.05);治疗7 d后,观察组患者WBC与对照组比较,差异无统计学意义(P>0.05),中性粒细胞水平及CRP水平均低于对照组患者(P<0.05)。观察组患者单器官衰竭与多器官衰竭发生率与对照组比较均无统计学差异(P>0.05)。观察组患者14、28、90 d死亡率与对照组患者比较,差异均无统计学意义(P>0.05)。结论:米卡芬净联合CRRT可以减轻脓毒症伴真菌感染患者的炎症反应,但并未明显改善患者生存结局。

Objective:To explore the impact of micafungin combined with continuous renal replacement therapy(CRRT)on the clinical outcomes of patients with sepsis and fungal infection.Methods:116 patients with sepsis accompanied by fungal infection were divided into an observation group and a control group according to the treatment method,58 cases in each group.The observation group was treated with mifepristine combined with CRRT,while the control group was treated with fluconazole combined with CRRT.The acute physiology and chronic health score system II(APACHEII)scores,white blood cell(WBC),neutrophils,C-reactive protein(CRP),and procalcitonin(PCT)levels before treatment,3 days of treatment,and 7 days of treatment were compared between the two groups,and their organ failure and survival outcomes were analyzed.Results:There was no significant difference in APACHEII scores between the observation group and the control group before treatment,at 3 and 7 d of treatment(P>0.05).There was no significant difference in WBC,neutrophil levels,CRP,and PCT levels between the observation group and the control group before treatment and at 3 days of treatment(P>0.05).However,there was no significant difference in WBC levels between the observation group and the control group at 7 days of treatment(P>0.05),and both neutrophil and CRP levels were lower than those in the control group(P<0.05).There was no significant difference in the incidence of single organ failure and multiple organ failure between the observation group and the control group(P>0.05).There was no significant difference in the 14,28,and 90 d mortality rate between the observation group and the control group(P>0.05).Conclusion:The combination of micafungin and CRRT can alleviate the inflammatory response in patients with sepsis and fungal infection,but it does not significantly improve the survival outcome of patients.