中华医院感染学杂志
中華醫院感染學雜誌
중화의원감염학잡지
Chinese Journal of Nosocomiology
2015年
9期
2077-2079
,共3页
化疗%侵入性真菌感染%临床诊治
化療%侵入性真菌感染%臨床診治
화료%침입성진균감염%림상진치
Chemotherapy%Invasive fungal infection%Clinical diagnosis and treatment
目的：探讨胃癌患者化疗后侵入性真菌感染的临床诊治情况，以期更好治疗真菌感染。方法选取2008年1月－2013年4月105例胃癌化疗后患者为研究对象，对其中出现侵入性真菌感染的37例患者从临床表现、危险因素和治疗方法等方面进行分析。结果胃癌化疗后侵入性真菌感染常见咯血、咳嗽、咳痰；骨髓像增生活跃，真菌G试验阳性，影像学为肺部大片实变影，双肺感染；病原菌主要分布在痰液和尿液中，常见病原菌为白色假丝酵母菌、光滑假丝酵母菌，占63．27％；APACHⅡ评分≥20分、年龄≥60岁、侵入性操作时间≥2周、化疗和放疗、全胃肠外营养、基础疾病等是胃癌化疗后侵入性真菌感染的危险因素（P＜0．05）；治疗后总有效率为45．95％，病死率为32．43％。结论胃癌化疗后侵入性真菌感染临床表现较明显，结合影像学和实验室检查可明确诊断，病原菌较为集中，采用卡泊芬净联合两性霉素B进行治疗临床效果显著。
目的：探討胃癌患者化療後侵入性真菌感染的臨床診治情況，以期更好治療真菌感染。方法選取2008年1月－2013年4月105例胃癌化療後患者為研究對象，對其中齣現侵入性真菌感染的37例患者從臨床錶現、危險因素和治療方法等方麵進行分析。結果胃癌化療後侵入性真菌感染常見咯血、咳嗽、咳痰；骨髓像增生活躍，真菌G試驗暘性，影像學為肺部大片實變影，雙肺感染；病原菌主要分佈在痰液和尿液中，常見病原菌為白色假絲酵母菌、光滑假絲酵母菌，佔63．27％；APACHⅡ評分≥20分、年齡≥60歲、侵入性操作時間≥2週、化療和放療、全胃腸外營養、基礎疾病等是胃癌化療後侵入性真菌感染的危險因素（P＜0．05）；治療後總有效率為45．95％，病死率為32．43％。結論胃癌化療後侵入性真菌感染臨床錶現較明顯，結閤影像學和實驗室檢查可明確診斷，病原菌較為集中，採用卡泊芬淨聯閤兩性黴素B進行治療臨床效果顯著。
목적：탐토위암환자화료후침입성진균감염적림상진치정황，이기경호치료진균감염。방법선취2008년1월－2013년4월105례위암화료후환자위연구대상，대기중출현침입성진균감염적37례환자종림상표현、위험인소화치료방법등방면진행분석。결과위암화료후침입성진균감염상견각혈、해수、해담；골수상증생활약，진균G시험양성，영상학위폐부대편실변영，쌍폐감염；병원균주요분포재담액화뇨액중，상견병원균위백색가사효모균、광활가사효모균，점63．27％；APACHⅡ평분≥20분、년령≥60세、침입성조작시간≥2주、화료화방료、전위장외영양、기출질병등시위암화료후침입성진균감염적위험인소（P＜0．05）；치료후총유효솔위45．95％，병사솔위32．43％。결론위암화료후침입성진균감염림상표현교명현，결합영상학화실험실검사가명학진단，병원균교위집중，채용잡박분정연합량성매소B진행치료림상효과현저。
OBJECTIVE To investigate the clinical diagnosis and treatment of invasive fungal infections in the gastric cancer patients after chemotherapy so as to facilitate the clinical treatment of the fungal infections .METHODS A total of 105 gastric cancer patients who underwent the chemotherapy from Jan 2008 to Apr 2013 were recruited as the study objects ,then the clinical manifestations of 37 patients with the invasive fungal infections ,risk factors , and treatment measures were observed .RESULTS Hemoptysis ,cough ,and expectoration were common in the gas‐tric cancer patients with invasive fungal infections after the chemotherapy ;the bone marrow like hyperplasia was active ,the fungal G test was positive ,the imaging showed large opacities of lungs ,and both lungs were infected . The pathogens were mainly isolated from sputum and urine;the Candida albicans and Candida glabrata were dominant among the pathogens ,accounting for 63 .27% .The risk factors for the invasive fungal infections in the gastric cancer patients after the chemotherapy included the APACHⅡ score no less than 20 points ,no less than 60 years of age ,length of invasive operation no less than 2 weeks ,chemotherapy and radiotherapy ,total parenteral nutrition ,and underlying disease (P<0 .05) .The total effective rate of the treatment was 45 .95% ,and the mor‐tality rate was 32 .43% .CONCLUSION The gastric cancer patients with invasive fungal infections show significant clinical manifestations after the chemotherapy ,the imaging examination combined with laboratory testing can facil‐itate the diagnosis .The pathogens are concentrated ,and caspofungin combined with amphotericin B can achieve significant clinical effect .
