高龄医院获得性肺炎患者预防性应用氟康唑抗真菌治疗的疗效分析

摘要

Objective:To investigate the efficacy of prophylactic use of fluconazole antifungal therapy in the elderly patients with hospital acquired pneumonia (HAP).Method:The clinical data of elderly patients who from January 2013 to December 2015 in our hospital diagnosed as HAP were collected.Useing the fungal infection risk factors scoring system by the West Virginia University School of Medicine established (Multi-disease Risk Assessment Program, MDRA) for grading ,MDRA score more than 25 points were selected with a total of 68 cases. According to whether prophylactic use of fluconazole ,the patients divided into prevention group and control group. The course of disease , the incidence of multiple organ dysfunction syndrome in elderly patients(MODSE), secondary fungal infection rate, fatality rate and incidence of adverse reactions were compared between the two groups.Result:The course of the prevention group was (14.20±2.87)d,the control group was (16.70±3.98)d, and the difference was statistically significant(P<0.05).The incidence of MODSE of the prevention group was 2 cases(6.5%), the control group was 9 cases(24.5%),and the difference was statistically significant (P<0.05).The incidence of fungal infection of the prevention group was 9.6%,the control group was 29.7%, and the difference was statistically significant (P<0.05).1 case was death in the prevention group and 7 cases were in the control group,the difference was statistically significant(P<0.05).In the prevention group before fluconazole stopped,there were 2 cases with ALT slightly elevated(46-80 mmol/L),timely after discontinuation of fluconazole,and no special treatment,alanine aminotransferase recovered to normal.Conclusion:Elderly hospital acquired pneumonia patients with prophylactic use of Fluconazole antifungal therapy can shorten the course of patients,improve the prognosis,it is worthy of clinical promotion.%目的：探讨高龄医院获得性肺炎（HAP）患者预防性应用氟康唑抗真菌治疗的疗效。方法：收集2013年1月-2015年12月于本院确诊为HAP的高龄患者资料，利用美国西弗吉尼亚大学医学院（WVUH）建立的真菌感染危险因素评分系统（Multi-disease Risk Assessment Program，MDRA）进行评分，筛选出MDRA评分≥25分的患者共68例，根据是否预防性应用氟康唑抗真菌治疗，分为预防组和对照组，统计对比两组患者的病程、老年多器官功能不全综合征（MODSE）发生率、继发真菌感染发生率、病死率及不良反应发生率。结果：预防组病程为（14.20±2.87）d，对照组为（16.70±3.98）d，差异有统计学意义（P<0.05）。预防组2例发生MODSE，对照组9例，差异有统计学意义（P<0.05）。预防组真菌感染发生率9.6%，对照组为29.7%，差异有统计学意义（P<0.05）。预防组1例患者死亡，对照组7例死亡，差异有统计学意义（P<0.05）。其中预防组2例在停氟康唑前出现了血谷丙转氨酶轻度升高（46~80 mmol/L），及时停用氟康唑后，未予特殊治疗，谷丙转氨酶均恢复正常。结论：对高龄医院获得性肺炎患者预防性应用氟康唑抗真菌治疗可以使患者病程缩短，预后改善，值得临床推广。