卡泊芬净治疗重症监护病房侵袭性真菌感染13例临床分析  

Efficacy and safety of caspofungin in the treatment of invasive fungal infection in 13 intensive care unit patients

作　　者：朱光发[1] 刘双[1] 张蔚[1] 杨京华[1] 刘泽英[1] 米玉红[2] 陆艳辉[2] 张京岚[3] 张颖[1] 宗华[1] 徐秋芬[1] 

机构地区：[1]首都医科大学附属北京安贞医院呼吸科北京市心肺血管疾病研究所,北京100029 [2]首都医科大学附属北京安贞医院急症科ICU,北京100029 [3]首都医科大学附属北京安贞医院外科ICU,北京100029

出　　处：《中国感染与化疗杂志》2007年第6期420-423,共4页Chinese Journal of Infection and Chemotherapy

摘　　要：目的探讨卡泊芬净治疗ICU侵袭性真菌感染（IFI）的疗效与安全性。方法回顾分析我院呼吸、急诊和外科ICU接受过卡泊芬净治疗的IFI患者临床资料。结果2005年5月—2006年11月共有13例接受了卡泊芬净治疗。13例中确诊IFI6例,包括念珠菌菌血症4例（白念珠菌2例,光滑念珠菌和近平滑念珠各1例）、肺IFI2例（光滑念珠菌和曲霉各1例）;拟诊肺IFI3例（白念珠菌1例,曲霉2例）;疑似肺IFI4例,病原真菌不明。基础疾病为心血管外科术后8例,骨科与普外科术后各1例,肺癌术后复发化疗、间质性肺疾病和成人Still′s病各1例。卡泊芬净中位疗程14（1~55d）d。1例于用药当天死于心脏骤停疗效无法判断,12例可评估患者中,痊愈4例（4/12,33.3%）,显效4例（4/12,33.3%）,总有效率（8/12,66.7%）,进步和无效各2例。死亡6例（6/13,病死率46.2%）。治疗过程中未发现与卡泊芬净有关的不良反应。结论卡泊芬净是治疗IFI有效、安全的药物,值得进一步临床验证。Objective To evaluate the efficacy and safety of caspofungin in the treatment of invasive fungal infection （IFI） in intensive care unit （ICU）. Methods A retrospective analysis of the clinical data was conducted for 13 patients with IFI and treated with caspofungin in 3 ICUs （respiratory, emergency and surgical）. Results From May 2005 to November 2006, 13 patients with IFI were treated with caspofungin, male 10, female 3, median age 67 （range 23-82） years old. Six were proven cases, including 4 candidemia （2 C. albicans, 1 C. glabrata and 1 C. parapsilosis） , 2 pulmonary IFI （1 C. glabrata and 1 Aspergillus species）, 3 probable cases （1 C. albicans and 2 Aspergillus species） and 4 possible pulmonary IFI （pathogen unknown）. Ten were post surgery patients （8 cardiovascular, 2 others）, the remaining 3 were internal medicine patients （1 received chemotherapy due to lung cancer, 2 received long term steroid therapy due to diffused interstitial lung disease and Still＇s disease respectively）. The median duration of the caspofungin therapy was 14 （range 1-55） days. Among the 12 evaluable patients （1 died of cardiac arrest at day 1 of the therapy and was excluded）, 4 were cured （4/12, 33. 3%）, 4 were markedly improved （4/12, 33.3%）. The overall effective rate was 66. 7% （8/12）. Two were improved and 2 failed, 6 died （death rate, 6/13, 46. 2%）. No drug-related side effect or adverse event was recorded. Conclusions Caspofungin is likely to be an effective and safe treatment for IFI in ICU patients, and warrants further clinical study.

关 键 词：卡泊芬净 侵袭性真菌感染 重症监护病房 念珠菌属 曲霉属 

分 类 号：R519[医药卫生—内科学]