两性霉素B胸膜腔灌洗治疗白色念珠菌性脓胸1例  

Clinical Study on Pleural Lavage for Pleural Empyema Due to Candida Albicans

作　　者：张英姿 邹建财 张志豪[2] 陈孝[2] 

机构地区：[1]江门市江海区人民医院,广东江门529080 [2]中山大学附属第一医院药学部,广东广州510080

出　　处：《今日药学》2016年第8期549-551,共3页Pharmacy Today

摘　　要：目的介绍两性霉素B胸膜腔灌洗治疗白色念珠菌性脓胸食管癌患者1例,为临床难治性脓胸治疗提供参考。方法患者经胸膜腔引流、全身分别应用米卡芬净7 d、两性霉素B使用5 d后脓胸无改善,临床医师与临床药师合作制定治疗方案,测定胸水两性霉素B浓度,发现低于其最低抑菌浓度(MIC)0.125~0.19μg/m L,给与两性霉素B胸膜腔灌洗治疗7 d。结果胸膜腔灌洗用药第7天胸水引流液性状明显改善,呈淡黄色清亮液体,引流通畅,培养阴性,并成功脱机拔管。结论两性霉素B胸腔灌洗联合全身使用两性霉素B治疗白色念珠菌性脓胸安全、可靠,临床药师协助治疗可改善难治性真菌脓胸临床疗效。OBJECTIVE To investigate the clinical results of pleural lavage for pleuralempyema due to Candida albicans in a 62- year-old female with esophageal carcinoma. METHODS The patient was treated with intravenous Micafungin for 7 d, and followed by amphotericin B for 5 d,but the pleural empyema was not improved. The concentration of amphotericin B in pleural effusion was lower than the MIC （0.125-0.19 I^g/mL）. Then the pleural lavage with amphotericin B was applied to the patient with systemic antifungal treatment. RESULTS There was clinical improvement in the pleural empyema with negative germicuhure after 7 d of pleural lavage. The chest tubes were removed after the drainage diminished and the consistency cleared. CONCLUSION The pleural lavage of amphotericin B for pleural empyema due to Candida albicans is safe, and may achieve good clinical effect. Close communication between the clinician and clinical pharmacists is important and may contribute to the treatment of Candida empyema thoracis.

关 键 词：白色念珠菌 脓胸 胸水 胸腔引流 两性霉素B 胸膜腔灌洗 临床药学 

分 类 号：R97[医药卫生—药品]