经纤维支气管镜肺泡灌洗两性霉素B联合伏立康唑在侵袭性肺真菌病中的应用

Application of bronchoalveolar lavage amphotericin B and voriconazole by fiberoptic bronchoscopy in invasive pulmonary fungal disease

目的：探讨经纤维支气管镜肺泡灌洗两性霉素B联合伏立康唑治疗侵袭性肺真菌病的临床效果和安全性。方法选择2011年9月~2015年8月我院SICU、RICU和神经外科收治的因各种疾病行气管切开，临床诊断为侵袭性肺真菌病的患者38例，随机分为观察组和对照组，每组19例。两组均给予伏立康唑针，首剂0.4g静滴，续以0.2g静滴，每12h一次，每日行纤维支气管镜肺泡灌洗治疗，灌洗结束时观察组在下气道保留两性霉素B 25mg，对照组不保留药物，疗程共15d。实验结束后，未治愈者继续按原方案治疗，直至治愈。结果治疗15d后观察组有效率（68.42%）与对照组有效率（27.78%）相比，差异有统计学意义（P<0.05）；观察组治愈天数（14.24±3.21）d较对照组治愈天数（25.21±4.34）d相比，差异有统计学意义（P<0.05）；观察组未出现因应用两性霉素B而引起的寒战、发热、皮疹、恶心呕吐、低钾血症、肝肾功能损害等。结论经纤维支气管镜肺泡灌洗两性霉素B联合伏立康唑治疗侵袭性肺真菌病，能够更有效地控制肺真菌感染，避免静脉应用两性霉素B所造成的副作用发生，缩短疗程，减少住院天数，降低患者经济负担，值得临床推广。

Objective To study the clinical efficacy and safety of bronchoalveolar lavage amphotericin B and voricona-zole by fiberoptic bronchoscopy in invasive pulmonary fungal disease. Methods Chose 38 cases of invasive pulmonary fungal disease patients from Sep 2011 to Aug 2015 in our hospital. Randomly divided the patients into observation group and control group,each group of 19 cases.Two groups were treated with voriconazole,the first dose of 0.4g intravenous drip,continued to 0.2g intravenous drip,once every 12 hours. Then observation group were treated with amphotericin B 25mg by bronchoscopy lavage and retained in the lower airway. Control group did not retain the drug. Course of treatment for 15d. At the end of the experi-ment,the patients who were not cured continue to be treated by the original plan until they were cured. Results After 15d of treatment,the effective rate of observation group (68.42%) was higher than control group(27.78%), and the difference was sta-tistically significant (P<0.05). The cure days (14.24±3.21)d in the observation group were statistically shorter than the control group (25.21±4.34)d (P<0.05). The observation group did not appear chills, fever,rash,nausea and vomiting,hypokalemia,liver and kidney dysfunction caused by amphotericin B. Conclusion The treatment of bronchoalveolar lavage amphotericin B and voriconazole for invasive pulmonary fungal disease is more effective to control the pulmonary fungal infection , avoid the occur-rence of side effects caused by intravenous amphotericin B,shorten course of treatment and the length of hospitalization,reduce the economic burden of the patients.