论文部分内容阅读
目的:观察伊曲康唑注射液和口服液序贯治疗中枢神经系统真菌感染的疗效,以及与两性霉素B和(或)氟胞嘧啶联合应用时的安全性。方法:采用开放性临床研究,自2004年6月-2005年9月间共收治17例中枢神经系统真菌感染,均采用伊曲康唑单独或联合两性霉素B和(或)氟胞嘧啶治疗,伊曲康唑注射液治疗至少1 wk以上。伊曲康唑注射液静脉滴注d 1～2为200 mg,q 12 h,d 3～14为200 mg·d-1;继之伊曲康唑口服液200 mg,q 12 h序贯治疗,两性霉素B 20～30 mg·d-1缓慢静脉滴注和(或)氟胞嘧啶6 g·d-1,分4次口服。结果:确诊病例14例,临床诊断病例3例,病原菌包括隐球菌、曲霉菌和小型无绿藻。2例治疗2 d死亡,未纳入疗效评估,临床总有效率为73％(11／15)。其中2例脑曲霉病、1例无绿藻脑膜炎、8例隐球菌脑膜炎(隐脑)均获痊愈;3例隐脑进步,1例侵袭性脑曲霉病无效死亡。治疗过程中,伊曲康唑注射液的不良反应主要为轻度肝功能异常,口服液治疗中部分病人有消化道症状,包括恶心、食欲下降,发生在服药2 mo以后。结论:伊曲康唑注射液和口服液单独或联合其他抗真菌药物治疗中枢神经系统真菌感染具有较好的疗效和安全性。
Objective: To observe the curative effect of itraconazole injection and oral liquid on sequential treatment of fungal infection of the central nervous system, as well as the safety of the combination with amphotericin B and / or flucytosine. Methods: In an open clinical study, 17 patients with central nervous system fungal infection were treated from June 2004 to September 2005. All patients were treated with itraconazole alone or in combination with amphotericin B and / or flucytosine , Itraconazole injection for at least 1 wk or more. Itraconazole injection d 1 ~ 2 was 200 mg, q 12 h, d 3 ~ 14 200 mg · d-1; followed by itraconazole oral solution 200 mg, q 12 h sequential treatment , Amphotericin B 20 ~ 30 mg · d-1 slow intravenous infusion and (or) flucytosine 6 g · d-1, 4 times orally. Results: 14 cases were diagnosed and 3 cases were diagnosed clinically. The pathogens include Cryptococcus, Aspergillus and Microcystis minor. 2 cases died of treatment 2 d, did not include the efficacy evaluation, the total clinical effective rate was 73% (11/15). Among them, 2 cases of aspergillosis, 1 case of no algae meningitis and 8 cases of cryptococcal meningitis (crypto) were cured; 3 cases of cryptotic progress, 1 case of invasive aspergillosis died. In the course of treatment, the adverse reactions of itraconazole injection were mainly mild liver dysfunction. Some patients in the oral liquid treatment had gastrointestinal symptoms, including nausea and loss of appetite, which occurred after 2 months of treatment. Conclusion: Itraconazole injection and oral solution alone or in combination with other antifungal drugs for the treatment of central nervous system fungal infection has good efficacy and safety.