呼吸科肺真菌病患者抗真菌药物治疗用药合理性的分析

发布时间：2018-01-05 12:33

本文关键词：呼吸科肺真菌病患者抗真菌药物治疗用药合理性的分析　出处：《广西医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探讨呼吸科肺真菌病患者在临床中抗真菌药物治疗用药合理性及抗真菌治疗的有效率。方法:回顾性分析2015年1月~2015年12月在广西医科大学第一附属医院住院的129例肺真菌病的患者的临床资料,分析其一般情况、基础疾病、高危因素、微生物学检查及病原学分布、抗真菌药物的用药情况及转归,并用统计学方法进行分析总结。结果:本研究共纳入129例肺真菌病患者,其中拟诊组76例,临床诊断组36例,确诊组17例。117例患者(90.70%)合并有基础疾病,以慢性阻塞性肺疾病(23.07%)、肺结核(21.37%)、支气管扩张(16.24%)最常见。使用广谱抗生素≥14天、侵入性操作、放疗及化疗、持续应用激素及免疫抑制剂、入住ICU等是肺真菌病的高危因素。129例肺真菌病患者中病原学检查送检率为93.02%,共检出真菌59株,其中念珠菌属25株(42.4%),曲霉菌属24株(40.7%),马尔尼菲青霉菌6株(10.2%),隐球菌属2株(3.4%),未明确菌种2株(3.4%)。研究中应用抗真菌药物治疗病例118例,评价药物应用合理101例,按DDD值分析方法显示氟康唑的DDDs最高,伏立康唑的DUI最高。对抗真菌药物治疗疗程≥7天的98例患者进行疗效评估,治疗总有效率为76.53%,其中,目标治疗组、先发治疗组、经验性治疗组的有效率分别为100%、77.78%、70.91%,三组间的有效率差异无统计学意义(P0.05);药物治疗方面,单药治疗组和联合用药治疗组的有效率分别为75.00%、83.33%,两组间的有效率差异无统计学意义(P0.05)。结论:1、肺真菌病患者常合并基础疾病高危因素2、肺真菌病常见的病原真菌是念珠菌属和曲霉菌属,常见的病原学检查方法是痰培养,有确诊意义的组织病理学检查相对较少。3、抗真菌治疗的常用药物是三唑类抗真菌药,本研究中大多数抗真菌药物的用药是合理的,但仍存在不合理现象,主要表现在:○1药物选择不当;○2未负荷剂量给药;○3给药频次不合理;○4疗程不足;○5联合用药不当。4、目标治疗、先发治疗及经验性治疗对肺真菌病都有一定的有效率,对于达到拟诊标准的患者早期行经验性治疗具有临床意义。5、单药治疗肺真菌病可达到较高的有效率,必要时可予联合用药治疗。
[Abstract]:Objective: to investigate the rationality of antifungal therapy and the effective rate of antifungal therapy in patients with pulmonary mycosis in respiratory department. The clinical data of 129 cases of pulmonary mycosis hospitalized in the first affiliated Hospital of Guangxi Medical University from January 2015 to December 2015 were analyzed retrospectively. Analysis of its general situation, basic diseases, high risk factors, microbiological examination and pathogenic distribution, antifungal drug use and outcome. Results: 129 cases of pulmonary mycosis were included in this study, including 76 cases in the scheduled diagnosis group and 36 cases in the clinical diagnosis group. In the confirmed group, there were 17 cases (90.70 cases) complicated with basic diseases, with chronic obstructive pulmonary disease (COPD) 23.077 and tuberculosis 21.3737). Bronchiectasis is most common. Use broad-spectrum antibiotics for more than 14 days, invasive operations, radiotherapy and chemotherapy, sustained use of hormones and immunosuppressants. Admission to ICU was the high risk factor of pulmonary mycosis. The rate of pathogenic examination was 93.022 in 129 cases of pulmonary mycosis. A total of 59 strains of fungi were detected, of which 25 strains of Candida were found to be 42.4). There were 24 strains of Aspergillus, 6 strains of Penicillium marneffei and 2 strains of Cryptococcus. In the study, 118 cases were treated with antifungal drugs, 101 cases were evaluated reasonably, and the DDDs of fluconazole was the highest according to DDD value analysis. The DUI of Volconazole was the highest. 98 patients who had been treated with antifungal drugs for more than 7 days were evaluated. The total effective rate was 76.53. Among them, the target treatment group was the first treatment group. The effective rate of empirical treatment group was 77.78 and 70.91, respectively. There was no significant difference in the effective rate among the three groups (P 0.05). In drug treatment, the effective rate of single drug treatment group and combined treatment group were 75.00 and 83.33, respectively. There was no significant difference in effective rate between the two groups (P 0.05). Conclusion: 1. Pulmonary mycosis patients often complicated with basic disease risk factors 2 the common pathogenic fungi of pulmonary mycosis are Candida and Aspergillus the common pathogenic method is sputum culture. The diagnostic significance of histopathological examination is relatively few. 3. Triazole antifungal drugs are commonly used in antifungal therapy. Most of the antifungal drugs in this study are reasonable, but there is still unreasonable phenomenon. The main manifestation was the improper choice of drug at 1: 01; 02 unloaded dose; The frequency of 03 administration was unreasonable; Insufficient course of treatment; 05 combined use of inappropriate. 4, target treatment, first treatment and empirical treatment for pulmonary mycosis have a certain effective rate, for patients who meet the criteria of early experience therapy has clinical significance 5. 5. The single drug treatment of pulmonary mycosis can achieve a high effective rate, if necessary, can be combined drug treatment.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R519

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