糖尿病酮症酸中毒并侵袭性肺曲霉病1例  

Diabetic ketoacidosis with invasive pulmonary aspergillosis:A case report

作　　者：梅昭[1] 谭月晴 奚炜[1] 邢翔飞[1] Mei Zhao;Tan Yue-qing;Xi Wei;Xing Xiang-fei(Dept.of Pharmacy,the People's Hospital of Three Gorges University·the First People's Hospital of Yichang,Hubei,YiChang 443000)

机构地区：[1]三峡大学人民医院·宜昌市第一人民医院药学部,宜昌443000

出　　处：《中国抗生素杂志》2021年第8期805-808,I0001,共5页Chinese Journal of Antibiotics

基　　金：湖北省卫生健康委员会联合基金项目(No.WJ2019H517)。

摘　　要：目的为糖尿病酮症酸中毒合并侵袭性肺曲霉病的抗感染治疗提供参考。方法临床药师参与1例糖尿病酮症酸中毒合并侵袭性肺曲霉病感染治疗的过程,通过查阅文献分析前期单药治疗效果不佳的原因,协助医师调整治疗方案,建议多药联合治疗,并对患者实施全程药学监护。结果患者积极补液降糖后,酮症和血糖被迅速纠正,同时医师采纳药师建议,予以伏立康唑联合卡泊芬净、辅以两性霉素B雾化吸入,患者肺部感染得到有效控制。出院伏立康唑序贯一月后复查肺CT较前明显吸收。在药师的监护与随访下,患者未出现药物不良反应。结论糖尿病酮症并侵袭性肺曲霉病,感染较重,宜考虑三唑与棘白菌素的联合、辅助两性霉素B雾化来提高治疗的成功率。Objective To provide a reference for the treatment of diabetic ketoacidosis with invasive pulmonary aspergillosis.Methods The clinical pharmacist participated in the treatment of a diabetic ketoacidosis patient with invasive pulmonary aspergillosis infection.By reviewing the literature and analyzing the reasons for the poor outcome of previous mono-drug therapy,the treatment plan was adjusted to multi-drug therapy.Pharmaceutical care for the patient was also provided by the pharmacist.Results The patient's ketoacidosis and high blood sugar level were quickly corrected with fluid infusion and insulin therapy.Voriconazole combined with caspofungin,together with amphotericin B nebulized inhalation were used as the antifungal therapy,and pulmonary infection of the patient was effectively controlled.The patient was prescribed with oral voriconazole upon discharge.Chest CT was performed one month after discharge and showed obvious absorption and improvement.No adverse drug reactions occurred with follow-ups by the pharmacist.Conclusion Diabetic ketoacidosis with invasive pulmonary aspergillosis is a life-threatening infection.Combination therapy with intravenous triazole and echinocandins as well as amphotericin B nebulized inhalation may be useful to achieve a better pharmacotherapy outcome.

关 键 词：侵袭性肺曲霉病 糖尿病酮症 药学实践 

分 类 号：R969.3[医药卫生—药理学]