葛洁 关月 乔逸 王婧雯

中圖分类号 R969.3 文献标志码 A 文章编号 1001-0408（2021）24-3038-06

DOI 10.6039/j.issn.1001-0408.2021.24.16

摘 要 目的：为临床儿童侵袭性真菌感染的诊治提供参考。方法：我院收治了4例病情较危重的侵袭性真菌感染男性患儿，年龄为3个月～17岁，疾病类型包括肺炎、心内膜炎、脑膜炎、肺部感染，感染病原菌涉及阿萨希毛孢子菌、葡萄牙假丝酵母菌、球形马拉色菌、季也蒙毕赤酵母菌、链格孢霉菌、克柔假丝酵母菌。临床药师全面跟踪治疗并回顾文献，协助医师制定治疗方案，分别给予氟康唑氯化钠注射液（6 mg/kg，静脉滴注，qd）、注射用醋酸卡泊芬净（负荷剂量32 mg，维持剂量25 mg，静脉滴注，qd）、氟康唑胶囊（400 mg，口服，qd）、注射用伏立康唑（200 mg，静脉注射，q12 h）+注射用醋酸卡泊芬净（负荷剂量70 mg，维持剂量50 mg，静脉注射，qd）等对症治疗，并密切监测患儿治疗过程中相关指标的变化情况和不良反应的发生情况。结果：医师采纳临床药师建议，3例患儿治疗后好转，1例患儿治疗后未愈;均无严重不良反应发生。结论：临床一旦发现类似感染应结合病原菌种类及耐药特征及时给予针对性治疗，以有效控制病情。本文可为类似真菌感染患儿提供治疗参考。

关键词 侵袭性真菌感染;病例分析;儿童;文献回顾

Analysis of 4 Cases of Fungal Infections in Children and Literature Review

GE Jie，GUAN Yue，QIAO Yi，WANG Jingwen（Dept. of Pharmacy， the First Affiliated Hospital of Air Force Military Medical University， Xi’an 710032， China）

ABSTRACT   OBJECTIVE： To provide a reference for the diagnosis and treatment of invasive fungal infection in children. METHODS： Four male children with invasive fungal infection in critical condition， aged from 3 months to 17 years， were treated in our hospital. The types of diseases included pneumonia， endocarditis， meningitis and pulmonary infection. The pathogens involved Trichosporon asahii， Candida portugal， Malassezia globosa， Pichia guilliermondii， Alternaria alternate and Candida krusei. Clinical pharmacists comprehensively followed up the treatment and reviewed the literature to assist doctors in formulating treatment plans. They provided Fluconazole sodium chloride injection （6 mg/kg， ivgtt， qd）， Caspofungin acetate for injection （loading dose 32 mg， maintenance dose 25 mg， ivgtt， qd）， Fluconazole capsules （400 mg， p.o.， qd） and Voriconazole for injection （200 mg， i.v.， q12 h）+Capofungin acetate for injection （loading dose 70 mg， maintenance dose 50 mg， i.v.， qd） and other symptomatic treatment， and closely monitored the changes of relevant indicators and the occurrence of ADR during the treatment of children. RESULTS： The doctor adopted the clinical pharmacist’s suggestion， three cases were relieved and one was not cured. No serious ADR was found. CONCLUSIONS： Once similar infections are found in clinic， timely targeted treatment should be given in combination with the types of pathogens and drug resistance characteristics， so as to effectively control the disease. The real cases provided in this article can provide evidence for the treatment of children with fungal infection.

KEYWORDS   Invasive fungal infection; Case analysis; Children; Literature review

基金项目：国家自然科学基金资助项目（No.72074218）

主管药师，硕士。研究方向：临床药学。电话：029-84775475。E-mail：183201508@qq.com

通信作者：副主任药师，博士。研究方向：临床药学。电话：029-84775475。E-mail：23395691@qq.com

据统计，20%～25%的世界人口存在某种形式的真菌感染，每年有超过200万人死于真菌感染，且真菌感染也是导致儿科人群发病和死亡的重要原因之一[1]。……