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1、PICU深部真菌感染研究和治疗［摘要］目的探讨儿童重症监护室(PICU)深部真菌感染的发生特点、病原学种类及治疗情况，提高诊治水平。方法选取2009年1月〜2011年6月PICU住院确诊为深部真菌感染的19例儿童为研究对象，回顾性分析其真菌感染的易感因素、病原学特点及抗真菌治疗效果。结果患儿基础疾病以肺部疾病最多见，占57.9%(11例)。易感因素有侵入性操作(19/19),使用广谱抗生素$4d(19/19),应用静脉营养(10/19)和应用呼吸机(9/19)。致病菌以白色念珠菌多见，占84.21%(16例)，热带念珠菌2例，新型隐球菌
2、1例。19例均给予抗真菌治疗。8例单用氟康吐(Flu),其余11例用二性霉素B脂质体(L—AMB)联合氟康11坐(Flu)治疗。13例治愈，4例好转，2例死亡。结论PICU儿童深部真菌感染与多种易感因素有关，白色念珠菌是儿童深部真菌感染的常见病原，氟康瞠(Flu)单用，或氟康哇(Flu)联合二性霉素B脂质体(L—AMB)是治疗儿童深部真菌感染的有效治疗方案。［关键词］儿童重症监护室；深部真菌感染；治疗；分析［中图分类号］R195.4［文献标识码］C［文章编号］1674—4721(2012)09(c)—0163—02Analysisand
3、treatmentofinvasivefungalinfectioninPICUWANGQiWANGJianminDepartmentofPICU,theFirstPeople，，sHospitalofShangqiuCityinHe，，nanProvince,Shangqiu476100,China[Abstract]ObjectiveToexploretheclinicalcharacteristics,fungalspeciesandthetreatmentofdeepfungalinfectioninPICU,andtoenha
4、ncethelevelofdiagnosisandtreatment・MethodsNineteenchildrenwithdeepfungalinfectionhospitalizedinPICUfromJanuary2009toJune2011wereselectedasobjectofstudy,predisposengfactors,pathogeniccharacteristicsandtreatmentefficacyoffungalinfectionwereretrospectivelyanalyzed.ResultsTh
5、emostcommonbasalillnesswaslungdisease,accountedfor57.9%(11cases)・Thereweresomepredisposingfactorssuchasinvasiveoperation(19/19),usingofbroad一spectrumantibioticsformorethan4days(19/19),intravenousnutrition(10/19)andmechanicalventilation(9/19)・Themostpathogenicbacteriumwas
6、Candidaalbicans,accountedfor84.21%(16cases),2casesofCandidatropicalis,1caseofcryptococcusneoformans.19casesweretreatedwithantifungaltherapy.Fluroconazole(Flu)wasusedalonein8cases,LiposomeAmphotericin(L一AMB)combinedwithFluroconazolewereusedin11cases.13caseswerecured,4case
7、swererelievedand2casesweredied.ConclusionChildreninvasivefungalinfectionrelativestolotsofpredisposingfactorsinPICU,themostpathogenicbacteriumisCandidaalbicans.FluorL一AMBcombinedwithfluiseffectivetherapeuticscheduleinthetreatmentofinvasivefungalinfectionofchildren.[Keywor
8、ds]PICU；Invasivefungalinfection；Treatment；Analysis近年来，由于PICU长时间广谱抗生素、糖皮质激素的使用，呼吸机及医源性侵入性操作的应用增多，PICU院内感
