重症急性胰腺炎合并深部真菌感染的预防和治疗  

Prevention and therapy of fungal infection in patients with severe acute pancreatitis

作　　者：何跃明[1] 吕新生[1] 艾中立[2] 刘志苏[2] 雷道雄[2] 王波涌[2] 钱群[2] 孙权[2] 陈纪伟[2] 欧新元[2] 徐睿[2] 江从庆[2] 袁玉峰[2] 曹军[2] 

机构地区：[1]中南大学湘雅医院外科,湖南长沙410008 [2]武汉大学中南医院外科,湖北武汉430071

出　　处：《中国普通外科杂志》2003年第2期83-86,共4页China Journal of General Surgery

摘　　要：目的　探讨重症急性胰腺炎 (SAP)合并深部真菌感染的预防和治疗措施。方法　将 1998年 7月～ 2 0 0 2年 6月收治的 70例SAP病人随机分 3组 :大蒜素预防组、氟康唑 (小剂量 )预防组、对照组 ,比较各组的真菌感染发生率 ,治疗后真菌清除率及死亡率。结果　大蒜素组真菌感染率明显低于对照组 (16%∶3 0 % ,P <0 .0 5 )及氟康唑组 (9%∶3 0 % ,P <0 .0 1)。真菌感染发生后 ,采用治疗剂量的氟康唑和两性霉素B对大蒜素组、对照组的真菌感染病人有效 ,而对氟康唑组真菌感染病人无效。结论　预防性应用大蒜素、小剂量氟康唑均可明显降低SAP的深部真菌感染发生率。真菌感染发生后 ,如氟康唑治疗无效 ,应及时改用两性霉素B。Objective To determine the prevention and therapy of fungal infection in patients with severe acute pancreatitis (SAP). Methods Seventy patients with SAP admitted from July,1998 to June,2002 were randomly divided into 3 groups: garlicin prevention group, fluconazole (low dosage) prevention group and control group.The incidence of fungal infection, the fungal clearance and mortality after the treatment were compared. Results The incidence of fungal infection in garlicin group and fluconazole group was lower than that in control group. (16%∶30%,P<0.05 and 9%∶30%,P<0.01,respectively).Amphotericin B or therapy dose fluconazole was effective for that if garlicim group and control group patiens occurred fungal infection,but had no effect on fluconzole group patients occurred fungal infection. Conclusions Prophylactic dosage of antifungal agents (garlicin or low dosage of fluconazole) could reduce the incidence of fungal infection in patients with SAP.But once fungal infection occurred,if fluconazole is not effective,amphotericin B should must be used as early as possible.

关 键 词：合并症 重症急性胰腺炎 深部真菌感染 预防 治疗 

分 类 号：R657.51[医药卫生—外科学] R519[医药卫生—临床医学]