伏立康唑与卡泊芬净治疗严重烧伤后真菌感染的临床对照观察

摘要/Abstract

摘要：

目的探讨伏立康唑与卡泊芬净治疗严重烧伤后真菌感染的临床治疗效果，为临床用药提供参考。方法收集本院2012年6月~2016年6月严重烧伤并发真菌感染患者共62例，利用随机数字表法分为两组。对两组患者在给予同等剂量的氟康唑静脉注射治疗的基础上，对照组30例使用卡泊芬净进行治疗，观察组32例使用伏立康唑进行治疗；分析62例患者的临床感染特征，并比较两种药物的治疗效果及其不良反应。结果临床感染症状主要包括体温高、脉搏异常、咽喉肿痛、咳嗽咯痰、精神异常、肺部阴影并存在啰音等；感染部位以创面感染为主；引发感染的真菌以白念珠菌与热带念珠菌为主，分别为55.93%和20.33%。观察组与对照组的治愈率分别为84.38%和86.67%，两组差异无统计学意义（P>0.05）；且两种药物的不良反应发生率都较低。结论对严重烧伤后合并真菌感染的患者，采用卡泊芬净与伏立康唑进行治疗，其临床效果显著且不良反应少，值得进一步推广使用。

关键词: 严重烧伤, 真菌感染, 卡泊芬净, 伏立康唑

Abstract:

Objective To explore the clinical effency of caspofungin and voriconazole on patients with severe burn complicated with fungal infections.Methods The clinical data of 62 patients with severe burn complicated with fungal infectionsin our hospital from June,2012 to June,2016 were collected.They were randomly divided into two groups according random number table.30 subjects who were treated with caspofungin were assigned to the control group,while 32 subjects in the observation group were treated with voriconazole.The clinical characteristics of the 62 patients were analyzed,and the clinical effects and the drug safety of the two groups were compared.Results The clinical symptoms included fever,pulmonary rales,sore throat,cough and expectoration,mental disorders,lung shadow and rale.The main infection sites were wound infection.And Candida albicans and Candida tropical were the main strains of fungi,which accounted for 55.93%and 20.33%,respectively.The total effective rates of the observation group and the control group were respectively 84.38% and 86.67%,and the difference between the two groups had no statistical significance (P>0.05).In addition,the incidence rates of the adverse reaction of the two groups were low.Conclusion Caspofungin and voriconazole had good clinical effect with less adverse reactions in the treatment of fungal infection secondary to severe burn.

Key words: severe burns, fungal infection, caspofungin, voriconazole

中图分类号:

R519

银西洋. 伏立康唑与卡泊芬净治疗严重烧伤后真菌感染的临床对照观察[J]. 中国真菌学杂志, 2017, 12(6): 352-355.

YIN Xi-Yang. The cinlical effency of caspofungin and voriconazole on fungal infections in severe burn patients[J]. Chinese Journal of Mycology, 2017, 12(6): 352-355.

参考文献

[1] 廖米荣,章伏生,叶礼岳,等.烧伤患者创面感染危险因素分析及预防对策[J].中华医院感染学杂志,2012,(21):4782-4784.
[2] Druyts E,Thorlund K,Humphreys S,et al.Interpreting discordant indirect and multiple treatment comparison meta-analyses:an evalution of direct acting antivirals for chronic hepatitis C infection[J].Clin Epidemiol,2013(5):173-183.
[3] 《中华烧伤杂志》编辑委员会.烧伤侵袭性真菌感染诊断与防治指南(2012 版)[J].中华烧伤杂志,2012,28(2):81-86.
[4] 杨惠忠,孙珍,向军,等.卡泊芬净治疗严重烧伤并发真菌感染的临床分析[J].中华烧伤杂志,2013,29(2):170-172.
[5] 孟帅,孙丽莹,朱立勤,等.伏立康唑与氟康唑治疗肝移植患者术后真菌感染的安全性比较[J].山东医药,2015,55(13):61-63.
[6] 陆敏秋,白砚霞,李真,等.伏立康唑治疗老年恶性血液病侵袭性真菌感染疗效分析[J].中华医院感染学杂志,2012,22(14):3153-3155.
[7] 骆雪萍,夏炳杰,叶宁.卡泊芬净治疗重症患者侵袭性真菌感染疗效及安全性评价[J].中华医院感染学杂志,2011,21(16):3480-3482.
[8] 余海燕,蔡国龙,陈进,等.伏立康唑治疗老年重症患者侵袭性真菌感染的疗效与安全性[J].中华医院感染学杂志,2014,24(1):102-104.
[9] Van Ness PH,Peduzzi PN,Quagliarello VJ.Efficacy and effectiveness as aspects of cluster randomized trials with nursing home residents:methodological insights from a pneumonia prevention trial[J].Contemp Clin Trials,2012,33(6):1124-1131.
[10] 张凯,朱家源,唐冰,等.慢性创面的病原菌调查分析[J].中华医院感染学杂志,2012,(11):2455-2457.
[11] Struck MF,Gille J.Fungal infections in burns:a comprehensive review[J].Ann iBurns iFire Disasters,2013,26(3):147-153.
[12] Walraven CJ,Mercier RC,Lee SA.Antifungal pharmacokinetics and dosing considerations in burn patients[J].Curr Fungal Infect Rep,2011,5(2):67-74.
[13] Katz T,Wasiak J,Cleland H,etal.Incidence of non-candidal fungal infections in severe burn injury:an Australian perspective[J].Burns,2014,40(5):881-886.
[14] 祖红旭,黄培信,李庆华.卡泊芬净治疗严重烧伤患者真菌感染的临床疗效分析[J].中华医院感染学杂志,2014,24(2):355-357.
[15] 方向京.对比伊曲康唑和卡泊芬净治疗严重烧伤患者真菌感染的疗效及安全性[J].现代诊断与治疗,2015,26(4):925-926.
[16] 黄志斌,柳晖,陈武鹏,等.伏立康唑治疗严重烧伤患者真菌感染临床疗效分析[J].中华医院感染学杂志,2015,25(23):5380-5382.