两性霉素B脂质体治疗早产儿侵袭性真菌感染的疗效  

Therapeutic Effect of Liposomal Amphotericin B on Premature Infants with Invasive Fungal Infections

作　　者：梁红[1] 周伟[1] 魏谋[1] 卢伟能[1] 张喆[1] 陈晓文[1] 

机构地区：[1]广州市妇女儿童医疗中心,广州市儿童医院新生儿科,广州510120

出　　处：《实用儿科临床杂志》2010年第8期596-598,共3页Journal of Applied Clinical Pediatrics

摘　　要：目的分析早产儿侵袭性真菌感染的高危因素、临床特征,观察两性霉素B脂质体治疗的有效性和安全性。方法回顾性分析21例侵袭性真菌感染早产儿的临床资料,根据临床特点、实验室检查确诊病例10例,临床诊断11例。应用两性霉素B脂质体治疗,剂量由0.1mg.kg-1.d-1开始,后每天或隔天加0.1mg.kg-1,每周复查1,3-β-D葡聚糖,结合临床继续增加至1～3mg.kg-1.d-1。同时每周监测肝肾功能及血常规。结果早产儿侵袭性真菌感染的高危因素是低胎龄儿、极低出生体质量儿、使用中心静脉导管、胃肠外营养、气管插管及长期应用抗生素。临床特征非特异性,各种体液培养以白色念珠菌为主;血1,3-β-D葡聚糖检测均>1500pg.L-1。本组治愈17例,有效2例,放弃、死亡各1例;未见明显不良反应。结论NICU中侵袭性真菌感染发病率日益增高,应重视其发病高危因素,血1,3-β-D葡聚糖监测非常必要,两性霉素B脂质体治疗早产儿侵袭性真菌感染安全、有效。Objective To analyze the risk factors and clinical features of invasive fungal infections in premature infants,and investigate the efficacy and safety of liposomal amphotericin B（L-AMB） treatment.Methods The clinical data of invasive fungal infection in 21 premature infants were retrospectively analyzed.All the cases were diagnosed by laboratory mycology examinations and clinically,among 10 infants were finally diagnosis,11 cases were in clinically.All of them were treated with L-AMB.The initial dose of L-AMB was 0.1 mg·kg-1·d-1,every day or previous day added 10 g,dose escalation to 1-3 mg·kg-1·d-1 was allowed.Simultaneous monitoring hepar and kidney functions and routine analysis of blood weekly.Results Very low birth weight,central venous catheter,intravenous hyperalimentation,tracheal cannula and antibiotics for long time were relevant risk factors.Clinical features were non-specificity;Candida albicans was main pathogenic fung;all 1,3-beta-D-glucan were 1 500 pg·L-1.Among the 21 cases,17 cases were cure,2 cases markedly improved,1 case was abandon and 1 case was death.There was no significant toxic and side-effect.Conclusions Invasive fungal infections rates in NICU are increasing and risk factors should be attention.Detection 1,3-beta-D-glucan is essentially.L-AMB get reliable effective and safety for invasive fungal infections in premature.

关 键 词：侵袭性真菌感染 高危因素 两性霉素B脂质体 婴儿 早产 

分 类 号：R722.6[医药卫生—儿科]