摘要
目的探讨儿童血液肿瘤患者深部真菌感染的临床特点及其诊断和治疗。方法对本院10例血液肿瘤患儿深部真菌感染进行回顾性分析，观察其发病时间、诱因，临床症状及X线、CT表现及治疗效果。通过血或痰等分泌物培养，组织病理、X线及CT检查等诊断。所有粒细胞缺乏并发热的肿瘤患儿用抗生素治疗3～5天无效即加用氟康唑（大扶康）预防真菌感染。确诊后大扶康无效者改用两性霉索B。结果10例深部真菌感染中绝大多数为真菌性肺炎8例（80％），热带念珠菌败血症1例，真菌鼻嬖炎2例（1例合并肺炎）。真菌性肺炎8例中有6例（85．7％）临床诊断曲霉菌肺炎，另外2例分别为青霉菌和光滑念珠菌肺炎。3例原发病未缓解者死亡，其他7例经有效抗真菌治疗好转。两性霉素B不良反应主要有：寒战、高热、低钾血症及一过性肾功能损害，均无需停药。结论深部真菌感染诊断困难，血液肿瘤患儿化疗后最常发生真菌性肺炎。粒细胞减少的发热患者抗生素治疗无效时应及早行肺部CT检查。曲霉菌肺炎典型CT改变为多发球形病灶，可伴空洞，呈“晕轮征”或“新月征”。曲霉菌性肺炎大扶康治疗无效，两性霉素B疗效肯定，无严重不良反应。原发病的缓解及粒细胞恢复也是真菌感染能否治愈的重要因素。
Objective To evaluate the characteristics and outcome of children with malignancy who developed deep fungal infections （DFI）. Methods： we reviewed the medical records of all patients in Department of Hematology/Oncology in our hospital from January 2000 to December 2004-for funsal infection. Results Among the 10 patients studied, 8 case of pulmonary, funsal infection （80%） was found , one case of septicemia of Candida tropicalis,and two case of nasosinusitis （one of which was concomitant with tungal pneumonia）. Six cases of pulmonary aspergillosis （85.7%） were diagnosed, one case of pulmonary glagabratosis, one case of is Penicillium The side effects of Arab incloud chili, fever, hypokalemia and transient defecency of kidney function while unnecessary of discontinuing on therapy. Conclusions Most common DFI is pulmonary fungal infection for immunosuppressant children with malignancy. It is difficult to diagnosis of DFI and it is very important in patients with neutropenic fever to be checked by CT timely. The typical X-ray exhibition of pulmonary aspergilllosis is multiple nodules or masses with ＂halo sign＂ or ＂air crescent sign＂. The curative effect of Arab is affirmed and no life - threatening side-effect was found in children. The recovery from neutropenia is also important for the treatment of DFI.
出处
《中国医刊》
CAS
2006年第4期44-46,共3页
Chinese Journal of Medicine
