本文選題：惡性血液病　切入點：侵襲性真菌病　出處：《河北北方學院》2017年碩士論文　論文類型：學位論文

【摘要】：本文研究目的在于結(jié)合惡性血液病合并侵襲性真菌病患者的臨床特點、病原學分布及影響療效的危險因素,對卡泊芬凈和米卡芬凈的臨床用藥進行合理性與藥物經(jīng)濟學評價分析,旨在為惡性血液病合并侵襲性真菌病的臨床藥物治療提供治療思路,并為卡泊芬凈和米卡芬凈的臨床應用提供參考依據(jù)。研究回顧性分析了2014年1月至2015年12月某三甲醫(yī)院收治的180例使用卡泊芬凈或米卡芬凈治療惡性血液病合并侵襲性真菌病患者的臨床資料,通過調(diào)查,匯總患者的病原學分布、感染部位、治療效果、住院成本、影響療效的危險因素及卡泊芬凈與米卡芬凈的使用情況等,同時運用SPSS 21.0軟件對數(shù)據(jù)進行統(tǒng)計學分析以達到研究目的。研究結(jié)果顯示從180例惡性血液病合并侵襲性真菌病患者的送檢標本中共分離出真菌75株,主要為念珠菌屬和曲霉菌屬,分別占69.34%和19.33%;主要感染部位為肺部,占93.88%;治療總有效率為44.44%,侵襲性真菌病相關死亡率為15.00%。抗真菌治療效果與三種及以上抗菌藥物聯(lián)合應用及患者肝功能狀況呈負相關,是影響抗真菌治療療效的獨立因素。抗真菌藥物使用過程中出現(xiàn)的不合理現(xiàn)象主要為治療時未給予負荷劑量以及維持劑量不合理,其中卡泊芬凈不合理使用率為42.74%,米卡芬凈不合理使用率為5.22%;本研究中藥物使用均無不良反應發(fā)生,安全性良好。藥物經(jīng)濟學研究采用成本-效果分析法,卡泊芬凈組總成本為273709.08元,米卡芬凈組總成本為227156.05元;卡泊芬凈組和米卡芬凈組的總有效率分別為35.00%和71.67%,以總有效率為判別標準,卡泊芬凈組與米卡芬凈組的C/E值分別為7820.26和3169.47,以總成本較小的米卡芬凈組作為參照,△C/△E為-1269.51,卡泊芬凈組每下降1個療效單位多花費1269.51元,米卡芬凈組比卡泊芬凈組更具成本-效果優(yōu)勢,是治療惡性血液病患者侵襲性真菌病的較優(yōu)藥物。以上結(jié)果表明惡性血液病合并侵襲性真菌病患者感染的病原菌以白色念珠菌為主;使用三種及以上抗菌藥物及肝功能不全都是影響療效的危險因素,應當避免濫用抗菌藥物,以及重視肝功能不全患者的用藥合理性及安全性。卡泊芬凈和米卡芬凈在惡性血液病患者中的不合理使用現(xiàn)象較普遍,用法用量及藥物相互作用等問題應當引起重視,建議加強抗真菌藥物使用的監(jiān)管。卡泊芬凈與米卡芬凈用于治療惡性血液病合并侵襲性真菌病時,米卡芬凈是較為經(jīng)濟有效的藥物。
[Abstract]:The purpose of this study was to combine the clinical characteristics, etiological distribution and risk factors of therapeutic effects of malignant hematologic diseases with invasive mycosis. The rationality and pharmacoeconomic evaluation of carpofen and mikafenjing in clinical use were analyzed in order to provide therapeutic ideas for the treatment of malignant hematological diseases with invasive mycosis. It provides reference for the clinical application of carpofen and mikafennet. A retrospective analysis of 180 cases of malignant hematological diseases treated with carpofen or mikafennet from January 2014 to December 2015 in a third class hospital was made. Clinical data of invasive mycosis, The etiological distribution, site of infection, therapeutic effect, hospitalization cost, risk factors affecting curative effect, and the use of carbophannet and mikafennet were collected by investigation. At the same time, the data were statistically analyzed by SPSS 21.0 software. The results showed that 75 strains of fungi were isolated from 180 patients with malignant hematopathy and invasive mycosis. Candida and Aspergillus accounted for 69.34% and 19.33 respectively. The total effective rate was 44.44 and the mortality rate of invasive mycosis was 15.00. The effect of antifungal therapy was negatively correlated with the combined use of three or more antimicrobial agents and the liver function of the patients. It is an independent factor that affects the curative effect of antifungal therapy. The unreasonable phenomenon in the course of antifungal drug use is that the dose is not given load and the maintenance dose is not reasonable. The unreasonable utilization rate of carpofen was 42.74, and that of mikafennet was 5.22. In this study, no adverse drug reaction occurred and the safety was good. Cost-effect analysis was used in pharmacoeconomics. The total cost of carpofen group was 273709.08 yuan, the total cost of mikafenjing group was 227156.05 yuan, the total effective rate of carpofen group and mikafennet group was 35.00% and 71.67 respectively, and the total effective rate was regarded as the criterion. The C / E values of carpofen group and mikafenjing group were 7820.26 and 3169.47, respectively. Taking Micafenin group with lower total cost as reference, the C / E ratio was -1269.51, and the cost of each therapeutic unit decreased by 1269.51 yuan in carpofen group. Micafefen group was more cost effective than carpofen group. The above results indicate that Candida albicans is the main pathogenic bacteria in patients with malignant hematologic diseases complicated with invasive mycosis. The use of three or more antimicrobial agents and liver function are not all risk factors affecting the curative effect, and the abuse of antimicrobial drugs should be avoided. The irrational use of carpofen and mikafenin in patients with malignant hematological diseases is common, and the usage and drug interaction should be paid more attention to. It is suggested that the administration of antifungal drugs should be strengthened. When Carpofen and Micafenem are used in the treatment of malignant hematological diseases complicated with invasive fungal diseases, mikafen is a more economical and effective drug.
【學位授予單位】：河北北方學院
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R519;R733

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