目的 阐述临床药师参与血液恶性肿瘤患者侵袭性真菌病药学会诊的价值。方法 研究经医院伦理委员会批准,回顾性分析2014年10月份至2016年6月临床药师参与会诊的血液系统恶性肿瘤患者侵袭性真菌病41例患者的临床资料,对其真菌构成、感染部位、合并细菌感染情况,进行分析。利用医院HIS系统随机抽取同期诊断血液恶性肿瘤患者侵袭性真菌病无临床药师会诊病例作为对照组,统计分析考察两组的疗效,借助典型病例阐述临床药师如何开展药学会诊。结果 41例药学会诊患者中检出45珠真菌,常见病原菌有白色念珠菌、光滑念珠菌、克柔念珠菌、热带念珠菌、曲霉菌、隐球菌均有检出,其中占白色念珠菌60.0%、克柔念珠菌11.1%、光滑念珠菌6.7%、热带念珠菌6.7%、曲霉菌属占13.3%,隐球菌2.2%;感染部位主要为肺部,其次消化道和血流感染。58.5%患者细菌培养阳性,常见合并菌有大肠埃希菌、铜绿假单胞菌和肺炎克雷白杆菌和嗜麦芽黄单胞菌等。经临床药师会诊治疗取得较好的效果:痊愈率为48.8%,显效率为34.2%,进步率为7.3%,总有效率为82.9%,无效率为9.2%,与无临床药师会诊组差异显著(P<0.05)。结论 恶性肿瘤患者真菌病常见的致病菌为念珠菌和曲霉菌,感染高发部位主要为呼吸道、泌尿系统和血液,合并细菌主要以革兰阴性菌,有些呈多耐药现象,临床药师通过药学会诊参与血液恶性肿瘤患者侵袭性真菌病的治疗,制定个体化的抗真菌治疗方案,保障患者用药安全、有效。

OBJECTIVE To explore how to carry out pharmaceutical consultation for anti-infection treatment in neutropenic hematological patients with invasive fugal disease and elaborate the value of clinical pharmacists in anti-infection treatment. METHODS A total of 41 hematologic malignancies patients with invasive fungal disease who were consulted by clinical pharmacist from October 2014 to June 2016 were enrolled into the study. The etiology, bacteria complication,and infection site were summarized. The other 41 agranulocytosis patients complicated with invasive fungal disease without clinical pharmacist consultation randomly sampled by HIS were used as the control. Statistical analysis were carried out to evaluate the effect of anti-infection treatment. The authors also discussed that as a clinical pharmacist how to carry out pharmaceutical consultation through several typical anti-fungal infection cases. RESULTS Totally 45 strains of fungi were isolated from the secretion specimens obtained from the 41 patients, including Candida albicans, Candida glabrata, Candidakrusei, Candida tropicalis, Aspergillums, and Cryptococcosis, among which Candida albicans accounted for 60.0%, followed by Aspetgillus (13.3%), Candidakrusei (11.1%), Candida glabrata (6.67%), Candida tropicalisi (6.67%), and Cryptococcosis (2.2%). The main infection site was the lung, followed by the digestive tract and blood stream. The positive rate of bacteria culture was 58.5% among the 41 patients, and the major isolated bacteria were Escherichia colis, Pseudomonas aeruginosa, Enterococcus, and Pseudomonas maltophilia. For the antifungal treatment involving the clinical pharmacists, the cure rate was 48.8%, the significant effective rate was 34.2%, the improved effective rate was 7.4%, the total effective rate of treatment was 72.9%, and the failure rate was 9.3%. There was significant difference in the curative effect between the clinical pharmacist consultation group and the control group (P<0.05). CONCLUSION The incidence of fungal infection in agranulocytosis patients is high, and most of the patients are complicated with bacteria infection. The most frequently infected site is respiratory tract. Clinical pharmacists can play an important role in the treatment of invasive fungal disease in agranulocytosis patients to ensure the treatment safety and efficacy.