【摘要】 目的:观察两性霉素B加血必净注射液早期经验性治疗ICU侵袭性真菌感染(IFI)的疗效和安全性。方法:465例危重患者入院后每天均经美国西弗吉尼亚大学医院IFI危险因素评分系统进行评估(分值≥40分)的86例患者纳入IFI经验性治疗,选用注射用两性霉素B。首日剂量5mg/d,第2d起每天增加5mg,第5d起25mg/d,用5%葡萄糖注射液500ml稀释,并加入地塞米松2.5～5mg,避光缓慢静滴,每次滴注时间10 h以上,平均治疗14.5d。同时使用血必净注射液50ml+0.9%氯化钠注射液250ml,静脉点滴,1次/12h,连用7d。对发生符合脓毒症诊断标准者继续应用7d。结果:86例患者中9例经治疗3天后病情恶化等原因而放弃治疗。可评价病例78例,有效69例(88.5%),无效9例(11.5%),两者比较差异有统计学意义(P<0.05)。两性霉素B的不良反应发生畏寒、寒颤、发热者11例(14.7%),低血钾12例(16%),血肌酐升高6例(8%),丙氨酸转氨酶升高2例(2.7%),未见神经系统毒性反应和过敏性休克、皮疹、静脉炎。结论:两性霉素B加血必净注射液早期经验性治疗ICUIFI临床疗效好,两性霉素B的不良反应发生率低可能与血必净注射液有关。更多还原

【Abstract】 Objective: To observe the efficiency and security of amphotericin B plus Xuebijing injection in early empirical treatment of invasive fungal infection in ICU. Methods:465 critically ill patients were included and assessed by the IFI scoring system every day.86 patients whose IFI scores were equal or greater than 40 were admitted in the empirical treatment. The amphotericin B produced by Shanghai New Pioneer Pharmaceutical Co., Ltd, was diluted with 500ml 5% glucose injection and plus dexamethasone 2.5～5mg. The dose was 5mg/ d in the first day and increased by 5mg/d afterwards until amounting to 25mg/d by the fifth day. The intravenous infusion should avoid light and require more than 10 hours. The average treatment time was 14.5 day. At the same time 50ml Xuebijing injection was added to 250ml physiological saline and began intravenous infusion 1/12h for consecutive 7d. Results:9 out of 86 patients gave up because of deterioration in the third day and some other reasons. Of the remaining 78 patients, 69(88.5%) patients are effective compared to 9(11.5%) and the difference was statistically significant. There are some adverse reactions of amphotericin B, including 11(14.7%) patients with chills and fever, 12(16%) patients with hypokalemia, 6 patients (8%) with high serum creatinine, 2(2.7%) patients with high alanine aminotransferase, but without nervous system toxicity, allergic shock, rash and phlebitis. Conclusions:The effect of amphotericin B plus Xuebijing injection in early empirical treatment of invasive fungal infection are significance and the incidence of adverse reactions is low. Maybe it is related to the dual pharmacological effects including reducing endotoxin levels, combating inflammatory mediators and improving immune function, especially reducing the incidence of adverse reactions of amphotericin B.更多还原