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目的评估氟康唑对极低出生体重儿真菌感染的预防作用。方法2007年3～12月入住我院新生儿重症监护病房的极低出生体重儿139例,随机分为预防组70例及对照组69例。所有患儿入院后根据病情给予对症治疗。预防组患儿于生后第8天起给予氟康唑口服治疗,剂量为6mg·kg-1.d-1,对照组给予奶粉口服。所有入选患儿用药7d后停药,继续观察停药后28d内患儿的各项指标,并定期行直肠真菌培养。结果预防组6/63例真菌培养阳性,对照组15/64例真菌培养阳性(χ2=4.453,P=0.034)。这21例培养阳性病例中,8例在用药后14d内出现,其中2例为预防组,6例为对照组。另13例为第15～28天培养阳性,其中预防组4例,对照组9例。所有21例培养阳性病例中,念珠菌属占16例(白色念珠菌9例,近平滑念珠菌4例,其他类型念珠菌3例),隐球菌3例,曲霉菌2例。结论预防性应用氟康唑能显著地降低真菌在直肠的定植,念珠菌属是最常见的定植菌种。有必要对极低出生体重儿采用高危因素评分法筛选其预防性应用氟康唑对象。
Objective To evaluate the preventive effect of fluconazole on fungal infections in very low birth weight infants. Methods From March to December 2007, 139 cases of very low birth weight infants admitted to neonatal intensive care unit in our hospital were randomly divided into prevention group (n = 70) and control group (n = 69). All children admitted to hospital according to the disease symptomatic treatment. The preventive group received oral treatment with fluconazole on the 8th day after birth at a dose of 6 mg · kg-1.d-1, while the control group was orally administered with powdered milk. All children were enrolled in the drug withdrawal after 7d, continue to observe the children within 28d after discontinuation of the indicators, and regular rectal fungal culture. Results 6/63 fungal cultures were positive in the prevention group, and 15/64 fungi in the control group were positive (χ2 = 4.453, P = 0.034). Of the 21 cases of positive culture, 8 cases appeared within 14 days after treatment, of which 2 cases were prevention group and 6 cases were control group. The other 13 cases for the first 15 to 28 days culture positive, including prevention group 4 cases, control group 9 cases. Candidiasis accounted for 16 cases (9 Candida albicans, 4 Candida parapsilosis, 3 Candida parapsilosis), 3 Cryptococcus neoformans and 2 Aspergillus in all 21 positive cases. Conclusion Preventive use of fluconazole significantly reduces the colonization of fungi in the rectum, and Candida species are the most common colonization strains. It is necessary to screened for prophylactic use of fluconazole in critically ill children with very low birth weight using the scoring system of risk factors.