恶性血液病并发肺部霉菌感染14例临床分析  

Clinical analysis of hematologic malignancies complicated pulmonary fungal infection (report 14 cases)

作　　者：文德顺 蒋宏玲 廖峥嵘 

机构地区：[1]湖南省永州市第三人民医院,湖南永州425000

出　　处：《中国医学工程》2009年第2期121-122,共2页China Medical Engineering

摘　　要：目的探讨恶性血液病合并肺部霉菌感染的发病原因,诊断及治疗。方法对14例患者进行临床症状、体征密切观察,收集体温、血常规、血和痰病原学结果、影像学诊断资料,抗生素及激素使用情况。结果14例中有呼吸道症状者11例,7例痰粘稠不易咳出,胸片检查11例可见大小不等的点片状阴影;白色念珠菌感染共10例(71.4%),曲霉菌感染2例;中性粒细胞<0.5×109/L者8例(占57.1%),<1.0×109/L者3例(占21.4%);均用广谱抗生素联合抗感染治疗7d以上;曲霉菌感染者给予二性霉素B,余12例用氟康唑治疗2周以上,6例治疗1周内症状改善消失(占42.9%),5例治疗2周内症状改善消失(占35.7%),3例死亡。结论恶性血液病合并肺部霉菌感染原因与强烈化疗、中性粒细胞减少、大量广谱抗生素的应用有关;其早期诊断较困难,临床应引起重视以便及时发现和治疗。[ Objective] To evaluate the etiological factors, diagnosis and therapy of puhnonary fungal infection in Hematologic Malignancies. [Methods] 14 cases with puhnonary fungal infection from clinical symptoms and signs, were observe in terms of body temperature BR, blood, phlegm etiology, iamge data, and use of antibiotics and hormone [Results] 11 out of 14 cases had the respiratory manifestations and sputum was thick and difficult to be expectorated in 7 cases. Chest X-rays showed shadows with features of stigma and sheet in 11 cases. 10 cases was infected by Candida albicans （71.4%）, and 2 cases were infected by aspergillus. The numbers of neutrophil were below 0.5×10^9/L in 8 cases （57.1%） and below 1.0×10^9/L （21.4%） in 3 cases respectively. Amphotericin B was gived to fungal infection patients, and Fluconazol was used for the other 12 cases and clinical symptoms of 11 cases were improved within two weeks, 3 cases was dead. [ Conclusions] The occurrence of pulmonary fungal infection in Hematologic Malignancies is associated with intensive chemotherapy, low neutrophil and broad-spectrum antibiotics application. It is difficult to make an early diagnosis, so clinicians should pay more attention to it.

关 键 词：霉菌感染 肺 恶性血液病 

分 类 号：R519[医药卫生—内科学]