氟康唑预防极低出生体重儿侵袭性真菌感染的临床观察  

Prophylactic effect of fluconazole in very low birth weight infants admitted to neonatal intensive care unit

作　　者：康莺歌[1] 常晶[1] 姚爱梅[1] 

机构地区：[1]郑州市妇幼保健院儿科,郑州450012

出　　处：《医药论坛杂志》2017年第2期31-33,共3页Journal of Medical Forum

摘　　要：目的评估氟康唑预防新生儿重症监护室极低出生体重儿侵袭性真菌感染的临床疗效。方法采用回顾性对照分析的方法,随机抽取2012年1月至2015年12月于郑州市妇幼保健院新生儿重症监护室住院的极低出生体重儿80例,随机分为预防组40例和对照组40例。所有患儿住院后均给予保暖、心电监护、肠外营养等对症支持治疗。两组患儿分别给予氟康唑(6mg/kg)或安慰剂治疗,第1~2周每72 h1次,第3~4周每48 h1次,4周后停药。持续观察至出院或28 d,研究的主要终点是患儿侵袭性真菌感染,次要终点是患儿真菌感染的归因死亡率或全因死亡率。结果与对照组患儿相比,氟康唑预防组发生侵袭性真菌感染的风险较低(43.2%,95%Cl 0.09~0.37,P<0.05)。其中,绝对危险降低率(ARR)22.2%,需治疗人数(NNT)5。氟康唑预防组的真菌感染死亡率较对照组低(2.6%:18.9%,95%Cl 0.003~0.52,P<0.05)。结论新生儿重症监护室极低出生体重儿氟康唑的预防性应用能够降低真菌感染的风险和死亡率。Objective To evaluate the effect of fluconazole prophylaxis on invasive fungal infection （IFI） in very low birth weight （VLBW） infants in the Neonatal Intensive Care Unit （NICU）. Methods Totally 80 premature infants ad- mitted to the neonatal intensive care unit （NICU） in our hospital were enrolled by the retroactive control analysis method from January 2012 to December 2015. 40 cases were flueonazole - group and 40 cases were control - group. Each case received warm,ECG monitoring and symptomatic treatment. VLBW infants were randomized to receive either fluconazole （ 6 mg/kg） or placebo, and fluconazole - group received flueonazole every two days in the first two weeks, then every oth- er day in the last two weeks till day 28 or discharge whichever was earlier. The primary outcome was IFI, and secondary outcome was fungal attributable mortality and all - cause mortality. Results Results The incidence of IFI was signifi- cantly lower in the fluconazole group compared to the control group （43.2% , 95% CI 0. 09 - 0. 37, P 〈0. 05）. The ARR （absolute risk reduction） was 22. 2% and the NNT （number needed to treat） was 5. Fungal attributable mortality was also lower in the iluconazole group （2. 6% versus 18.9%, 95% CI 0. 003 - 0. 52, P 〈 0. 05）. Conclusion Use of flueonazole prophylaxis of VLBW neonates in the NICU decreases IFI and fungal attributable mortality.

关 键 词：氟康唑 极低出生体重 婴儿 真菌感染 

分 类 号：R978.5[医药卫生—药品]