42例老年晚期肺癌并发肺部真菌感染的临床分析  

Clinical analysis of 42 elderly patients with late stage lung cancer and pulmonary fungal infections

作　　者：曹晓艳[1] 刘睿[1] 杨照环[1] 邱林 

机构地区：[1]唐山市工人医院放化疗科,河北唐山063000 [2]唐山市康复医院放化疗科,河北唐山063000

出　　处：《中华医院感染学杂志》2012年第14期3034-3035,共2页Chinese Journal of Nosocomiology

摘　　要：目的分析老年晚期肺癌合并肺部真菌感染的病原菌构成、耐药性及治疗措施。方法选择医院2006年6月-2010年12月42例老年晚期肺癌并发肺部真菌感染患者,进行真菌检测及药敏试验,对感染病原菌种类、药敏状况及治疗结果进行分析。结果 42例患者痰培养出真菌42株,其中白色假丝酵母菌24株占57.1%,光滑假丝酵母菌9株占21.4%,热带假丝酵母菌4株占9.5%,克柔假丝酵母菌4株占9.5%,曲霉菌属1株占2.4%;白色假丝酵母菌对氟康唑、5-氟胞嘧啶、伊曲康唑敏感,仅2株对酮康唑耐药,所有菌株均对伊曲康唑敏感;根据真菌培养结果对症治疗后39例好转,再次痰培养结果显示阴性,死亡3例,系合并低蛋白血症、糠尿病及严重贫血,死于多脏器功能衰竭。结论老年晚期肺癌患者由于肺不张,慢性阻塞性肺疾病等导致肺部易有细菌定植,由于疾病进展或者化疗后,身体免疫力低下,容易继发肺部真菌感染,化疗期间应增加免疫力并密切观察,发现感染,积极治疗,可改善预后。OBJECTIVE To analyze the distribution and the drug resistance of the pathogens causing pulmonary infections in elderly patients with late stage lung cancer and the treatment measures.METHODS A total of 42 patients with late stage lung cancer and pulmonary fungal infections from Jun 2009 to Dec 2010 were selected,the fungal detection and the drug susceptibility testing were performed,the species of the pathogens causing infections,drug susceptibility and the therapeutic effect were analyzed.RESULTS There were 42 strains of fungi which were cultured from the sputum of 42 patients,including 24（57.1%） strains of Candida albicans,9（21.4%） strains of C.glabrata,4（9.5%） strains of C.tropicalis,4（9.5%） strains of C.krusei,and 1（2.4%） strain of Aspergillus;the drug susceptibility testing showed that C.albicans was susceptible to fluconazole,flucytosine,and itraconazole,only 2 strains were susceptible to ketoconazole,and that all the isolates were susceptible to itraconazole;totally 39 cases have been improved after symptomatic treatment in accordance with the fungal culture,the sputum culture showed negative,3 cases died due to multiple organ failure combined with hypoalbuminemia,diabetes and severe anemia.CONCLUSION Because the patients with advanced lung cancer before the lungs have been infected with bacterial colonization and low body immunity after chemotherapy are easy to be with secondary pulmonary infections;it is necessary to intensify and closely observe the immunity during the chemotherapy so as to diagnose and treat the infections as well as improve the prognosis.

关 键 词：肺癌晚期 老年患者 肺部 真菌感染 

分 类 号：R181.32[医药卫生—流行病学]