血液恶性肿瘤患者侵袭性真菌病药学会诊分析

发布时间：2018-01-15 12:09

本文关键词：血液恶性肿瘤患者侵袭性真菌病药学会诊分析　出处：《中国药学杂志》2017年05期 　论文类型：期刊论文

【摘要】：目的阐述临床药师参与血液恶性肿瘤患者侵袭性真菌病药学会诊的价值。方法研究经医院伦理委员会批准,回顾性分析2014年10月份至2016年6月临床药师参与会诊的血液系统恶性肿瘤患者侵袭性真菌病41例患者的临床资料,对其真菌构成、感染部位、合并细菌感染情况,进行分析。利用医院HIS系统随机抽取同期诊断血液恶性肿瘤患者侵袭性真菌病无临床药师会诊病例作为对照组,统计分析考察两组的疗效,借助典型病例阐述临床药师如何开展药学会诊。结果 41例药学会诊患者中检出45珠真菌,常见病原菌有白色念珠菌、光滑念珠菌、克柔念珠菌、热带念珠菌、曲霉菌、隐球菌均有检出,其中占白色念珠菌60.0%、克柔念珠菌11.1%、光滑念珠菌6.7%、热带念珠菌6.7%、曲霉菌属占13.3%,隐球菌2.2%;感染部位主要为肺部,其次消化道和血流感染。58.5%患者细菌培养阳性,常见合并菌有大肠埃希菌、铜绿假单胞菌和肺炎克雷白杆菌和嗜麦芽黄单胞菌等。经临床药师会诊治疗取得较好的效果:痊愈率为48.8%,显效率为34.2%,进步率为7.3%,总有效率为82.9%,无效率为9.2%,与无临床药师会诊组差异显著(P0.05)。结论恶性肿瘤患者真菌病常见的致病菌为念珠菌和曲霉菌,感染高发部位主要为呼吸道、泌尿系统和血液,合并细菌主要以革兰阴性菌,有些呈多耐药现象,临床药师通过药学会诊参与血液恶性肿瘤患者侵袭性真菌病的治疗,制定个体化的抗真菌治疗方案,保障患者用药安全、有效。
[Abstract]:Objective to expound the value of clinical pharmacists in the diagnosis of invasive mycosis in patients with hematologic malignancy. Methods the study was approved by the Hospital Ethics Committee. From October 2014 to June 2016, the clinical data of 41 patients with invasive mycosis of hematological malignancy who were consulted by clinical pharmacists were analyzed retrospectively. The fungal composition and infection site were analyzed. Hospital HIS system was used to randomly select the patients with invasive mycosis in the same period as the control group. Statistical analysis of the efficacy of the two groups, with the help of typical cases of clinical pharmacists how to carry out pharmaceutical consultation. Results 41 cases of pharmaceutical patients detected 45 beads fungi, common pathogens are Candida albicans. Candida smooth, Candida krolimus, Candida tropicalis, Aspergillus sp., Cryptococcus were detected, which accounted for 60. 0% of Candida albicans, 11. 1% of Candida korgii and 6.7% of Candida smooth. Candida tropicalis 6.7m, Aspergillus 13.3 and Cryptococcus 2.2; The infection was mainly located in the lungs, followed by infection of digestive tract and blood stream. 58.5% of the patients were positive for bacterial culture, and the common bacteria were Escherichia coli. Pseudomonas aeruginosa, Klebsiella pneumoniae and Xanthomonas maltophilia, etc. Good results were obtained by consultation with clinical pharmacists: the cure rate was 48.8%, the effective rate was 34.2%, and the improvement rate was 7.3%. The total effective rate was 82.9 and the ineffective rate was 9.2. The difference between the two groups was significant (P 0.05). Conclusion Candida and Aspergillus are common pathogenic bacteria in patients with malignant tumor. The high incidence of infection is mainly respiratory tract, urinary system and blood, combined with bacteria mainly Gram-negative bacteria, some show multi-drug resistance phenomenon. Clinical pharmacists take part in the treatment of invasive mycosis in patients with hematologic malignancy through pharmaceutical consultation, and formulate individualized antifungal therapy to ensure the safety and effectiveness of drug use.
【作者单位】：汕头大学医学院附属粤北人民医院;广东药科大学;
【分类号】：R733;R519
【正文快照】： 血液系统恶性肿瘤是常见的血液系统疾病,随着肿瘤化疗、糖皮质激素及广谱抗菌药物的广泛应用,血液系统恶性肿瘤患者侵袭性真菌感染(inva-sive fungal infection,IFI)的风险也随之增加。有报道造血系统恶性肿瘤患者中性粒细胞缺乏伴真菌感染16%~37%,其中相关死亡率高达11%。血

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