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--> 00:00.766\n嗯，\n\n00:00.766 --> 00:01.866\n各位听众啊，\n\n00:01.866 --> 00:02.691\n各位朋友，\n\n00:02.990 --> 00:09.590\n那么我们今天来学习一下免疫功能低下患者的肺部感染的药物选择。\n\n00:10.305 --> 00:12.904\n你今天的那个这个题目，\n\n00:12.904 --> 00:16.805\n主要还是一个肺部感染的一个真菌感染的药物。\n\n00:17.525 --> 00:19.676\n我们下面慢慢的要学习一下。\n\n00:20.759 --> 00:23.858\n那么首先要什么叫免疫缺陷，\n\n00:24.309 --> 00:24.708\n嗯，\n\n00:24.909 --> 00:26.208\n这个患者，\n\n00:26.208 --> 00:27.384\n那么，\n\n00:27.384 --> 00:29.259\n这个定义我们要明确一下。\n\n00:30.100 --> 00:35.275\n那么正常人具有是具有一个物理的和化学的屏障的是，\n\n00:35.275 --> 00:39.174\n还有还有一个非特异性的免疫和特异性免疫功能，\n\n00:39.325 --> 00:42.924\n以防御各种病原体的入侵。\n\n00:43.375 --> 00:50.424\n任何影响和损伤这些免疫功能的因素都可以使得他这种人。\n\n00:51.471 --> 00:53.070\n容易发生感染，\n\n00:53.221 --> 00:55.770\n我们称之为免疫缺陷性感染。\n\n00:56.361 --> 00:57.335\n免疫缺陷者，\n\n00:57.335 --> 00:59.611\n它分为原发性的，\n\n00:59.611 --> 01:03.960\n也就是先天性的和继发性也就是获得性的这两种。\n\n01:04.710 --> 01:09.560\n获得性免疫缺陷者的感染既有创伤、异物、营养不良。\n\n01:10.613 --> 01:15.914\n肿瘤、脾切除药物跟某些病原体等组织的免疫缺陷而产生的感染。\n\n01:17.446 --> 01:20.247\n那么我们再看一下免疫缺陷者感染的类型。\n\n01:24.472 --> 01:27.023\n这类型类型有有啊，\n\n01:27.023 --> 01:30.623\n第一种是皮肤粘膜的完整性数据，\n\n01:30.722 --> 01:40.797\n比方说创伤、烧伤等各种导导管放置、心瓣膜置换术等皆可引起局部的防御障屏障损伤，\n\n01:40.797 --> 01:44.947\n导致其邻近部位即植病原体微生物入侵，\n\n01:44.947 --> 01:45.922\n形成了感染。\n\n01:46.476 --> 01:52.126\n各种实体瘤所致的空腔器官阻塞也可以损伤局部防御功能，\n\n01:52.126 --> 01:53.976\n使感染易于发生。\n\n01:54.277 --> 01:56.077\n如支气管肺癌患者。\n\n01:56.759 --> 01:58.109\n容易导致肺部感染。\n\n01:59.691 --> 01:59.841\n那么，\n\n01:59.841 --> 02:00.265\n第二是，\n\n02:00.265 --> 02:03.115\n第四是细胞缺免疫缺陷。\n\n02:03.115 --> 02:04.591\n比方说淋巴瘤的患者，\n\n02:04.591 --> 02:07.191\n肿瘤病人、接受放疗或化疗者，\n\n02:07.191 --> 02:10.541\n器官移植及应用免疫抑制剂者啊，\n\n02:10.541 --> 02:13.916\n也包括结核获得性免疫缺陷综合征，\n\n02:13.916 --> 02:17.391\n也就是那个ARDS的这个患者。\n\n02:18.904 --> 02:20.404\n第三是体液免疫缺陷，\n\n02:20.404 --> 02:25.054\n主要被主要包括免疫球蛋白和补体的缺乏。\n\n02:25.354 --> 02:32.203\n体液免疫缺陷者因而容易发生肺炎球菌、流感杆菌、脑膜。\n\n02:33.033 --> 02:38.283\n炎菌等所致的肺炎、脑膜炎以及某些病毒感染。\n\n02:40.162 --> 02:44.861\n感染已成为免疫力低下患者的一个非常重要的、首要的问题。\n\n02:45.162 --> 02:50.212\n感染是肿瘤患者最常见的合并症和主要的死亡。\n\n02:51.695 --> 02:55.595\n60%.75%的白血病病人或淋巴瘤患者，\n\n02:55.595 --> 03:00.796\n和40%.5%的实体瘤的患者的主要死亡原因是感染。\n\n03:01.145 --> 03:04.746\n病人血中的中性粒细胞低于五百，\n\n03:04.845 --> 03:06.945\n感染的风险是明显增大的。\n\n03:07.585 --> 03:14.136\n患有脓绿脓杆菌脓毒症、中性粒细胞低下的病人能在24小时内死亡。\n\n03:18.024 --> 03:18.274\n嗯，\n\n03:18.675 --> 03:23.074\n革兰氏阴性菌是引起免疫力低下患者的主要致病菌之一。\n\n03:23.274 --> 03:23.574\n嗯，\n\n03:23.574 --> 03:28.125\n特别是大肠杆菌、绿脓杆菌和克雷伯杆菌，\n\n03:28.175 --> 03:32.175\n约占所有病原微生物的60%.80%。\n\n03:32.425 --> 03:34.074\n在ICU病房中，\n\n03:34.074 --> 03:36.925\n绿脓杆菌的发生率可高达29%，\n\n03:36.925 --> 03:40.324\n而患有败血症新生儿中也达到了25%。\n\n03:41.522 --> 03:43.121\n免疫缺陷者常出现发烧，\n\n03:43.121 --> 03:45.496\n应该首先考虑是感染的可能。\n\n03:45.496 --> 03:49.746\n免疫力低下患者的抗生素的基本原则要广谱、高效，\n\n03:49.746 --> 03:50.722\n安全性高。\n\n03:52.679 --> 03:57.880\n肺部的真菌感染也是免疫力低缺陷患者的常见的感染原因。\n\n03:59.425 --> 04:02.949\n那肺部真菌感染的高发危险因素都包括哪些呢？\n\n04:02.949 --> 04:03.375\n第一，\n\n04:03.524 --> 04:04.574\n恶性肿瘤，\n\n04:04.824 --> 04:07.125\n尤其是血液的恶性肿瘤，\n\n04:07.125 --> 04:08.824\n比方说白血病、淋巴瘤，\n\n04:08.975 --> 04:10.725\n第二是静脉插管，\n\n04:11.074 --> 04:13.175\n第三是放化疗，\n\n04:14.024 --> 04:15.975\n损伤了患者的免疫功能。\n\n04:16.024 --> 04:18.875\n第四是广谱抗生素的长期应用，\n\n04:19.125 --> 04:22.325\n第五是迁延的粒细胞减少期。\n\n04:23.213 --> 04:24.562\n第六是艾滋病患者，\n\n04:24.562 --> 04:29.363\n也就是后天性的获得性免疫缺陷综合征。\n\n04:29.412 --> 04:31.488\n第七是器官移植，\n\n04:31.488 --> 04:34.513\n器官移植的患者应该长期是使用免疫抑制剂的。\n\n04:35.078 --> 04:38.127\n第八是不明原因的精神过神志障碍。\n\n04:38.227 --> 04:40.877\n第九是应用糖皮质激素。\n\n04:42.007 --> 04:44.358\n等药物治疗的患者长期使用。\n\n04:45.519 --> 04:45.820\n还有。\n\n04:47.294 --> 04:47.506\n另外，\n\n04:47.506 --> 04:48.644\n还有糖尿病患者，\n\n04:48.644 --> 04:50.618\n他的免疫力也是低的啊。\n\n04:50.618 --> 04:52.544\n免疫功能低下的患者，\n\n04:52.794 --> 04:55.644\n组织坏死或损伤或坏死。\n\n04:55.644 --> 04:56.069\n另外，\n\n04:56.069 --> 04:58.544\n全胃肠外营养的患者。\n\n04:59.092 --> 04:59.191\n那么，\n\n04:59.191 --> 05:01.717\n另外入住ICU大于四天，\n\n05:01.717 --> 05:03.441\n机械通讯大于四十八天，\n\n05:03.441 --> 05:04.617\n怕是二啊，\n\n05:04.617 --> 05:10.166\n怕是two评分大于十都可以会引起那个肺部的真菌感染。\n\n05:10.166 --> 05:10.617\n另外，\n\n05:10.617 --> 05:15.367\n腹部手术念珠菌定值大于两处念珠菌，\n\n05:15.367 --> 05:17.291\n尿大于十到五次方，\n\n05:17.291 --> 05:19.342\n都是导致肺部感染，\n\n05:19.342 --> 05:21.992\n肺部真菌感染的高高危因素。\n\n05:23.614 --> 05:24.313\n这样我们看一下，\n\n05:24.313 --> 05:27.588\n有55例的念珠菌菌血症的患者，\n\n05:27.588 --> 05:31.364\n他所合并有的原发的疾病。\n\n05:31.364 --> 05:31.688\n嗯，\n\n05:31.688 --> 05:32.963\n这以此这个表，\n\n05:32.963 --> 05:36.664\n我们可以看到它是一个恶性肿瘤啊，\n\n05:36.664 --> 05:38.563\n占百分占47%，\n\n05:38.813 --> 05:41.264\n粒细胞减少占11%，\n\n05:41.463 --> 05:43.563\n腹部手术占10%。\n\n05:44.213 --> 05:44.614\n那么，\n\n05:44.614 --> 05:46.914\n重症胰腺炎占8%啊，\n\n05:46.914 --> 05:49.764\n6%的患者是慢性肺病的患者，\n\n05:49.813 --> 05:52.688\n4%的患者是SLE，\n\n05:52.688 --> 05:53.813\n也就是红斑狼疮。\n\n05:54.053 --> 05:58.653\n还有先心病、早产儿、肝硬化、肾移植、外伤，\n\n05:58.752 --> 06:00.453\n这些都是一种，\n\n06:00.852 --> 06:04.153\n发生念珠菌感染的高危因素。\n\n06:06.930 --> 06:07.781\n支气管肺部，\n\n06:07.881 --> 06:11.256\n支气管肺部的真菌的感染的诊断，\n\n06:11.256 --> 06:12.555\n那么怎么诊断呢？\n\n06:12.555 --> 06:16.830\n就是说我们最好是通过活体的组织检测证实，\n\n06:16.930 --> 06:22.480\n确实在组织内有真菌侵入性的感染的组织学证据。\n\n06:24.489 --> 06:26.239\n那么临床临床如何诊断呢？\n\n06:26.239 --> 06:29.188\n那么临床诊断主要是满足以下几条，\n\n06:29.438 --> 06:30.039\n第一，\n\n06:30.139 --> 06:31.838\n原来有肺部疾病，\n\n06:31.889 --> 06:36.139\n经足量的抗生素或中规的抗感染治疗后无效，\n\n06:36.338 --> 06:37.789\n病情持续恶化，\n\n06:37.789 --> 06:40.539\n尤其是长期了使用的激素，\n\n06:40.739 --> 06:41.739\n糖皮质激素，\n\n06:41.739 --> 06:45.264\n广谱抗生素或免疫功能低下的患者。\n\n06:45.264 --> 06:47.389\n首先这个如果这种患者。\n\n06:48.234 --> 06:50.309\n长期使用这种激素啊，\n\n06:50.309 --> 06:51.484\n广谱抗生素啊，\n\n06:51.484 --> 06:53.660\n或者这种合并有免疫低下的患者，\n\n06:53.660 --> 06:55.410\n那么我们要考虑啊，\n\n06:55.410 --> 06:57.285\n可能会合并有真菌感染。\n\n06:57.434 --> 06:57.984\n第二，\n\n06:57.984 --> 07:00.160\nX线检查出现了新的病灶，\n\n07:00.160 --> 07:03.984\n尤其是弥漫性斑片或网格状阴影，\n\n07:04.285 --> 07:08.834\n不能用细菌性的或病毒性的肺炎来解释的，\n\n07:08.834 --> 07:11.635\n那么这个时候我们要想到是真菌性的感染。\n\n07:12.205 --> 07:12.506\n第三，\n\n07:12.705 --> 07:21.006\n经支气管支气管封闭毛刷或毛细支气管肺泡灌洗培养到能培养到真菌，\n\n07:21.156 --> 07:22.980\n那么我们诊断是这样的一条，\n\n07:22.980 --> 07:28.256\n第一条加第三条或者第二加第三条可就可以临床诊断。\n\n07:28.406 --> 07:28.805\n那么，\n\n07:28.805 --> 07:30.406\n我们再次强调肺。\n\n07:31.328 --> 07:37.227\n再次强调肺部的真菌病多见于也可见于无基础疾病的健康人。\n\n07:37.227 --> 07:38.977\n与肺曲霉病。\n\n07:40.269 --> 07:41.170\n可能的感染，\n\n07:41.470 --> 07:46.869\n那么如果出现了器官功能障碍并发生有真菌定植的证据，\n\n07:47.119 --> 07:51.670\n例如在痰液中、尿液中、胆汁中培养时发现的真菌，\n\n07:51.820 --> 07:58.119\n医生应该根据患者临床表现对可能发生的真菌感染进行抗真菌治疗。\n\n07:58.980 --> 07:59.755\n那么我们看一下，\n\n07:59.755 --> 08:03.730\n在我们219181998年至2006年，\n\n08:03.730 --> 08:06.880\n中国前六位的酵母菌的感染多见于哪些？\n\n08:06.880 --> 08:09.804\n第一是白色嗯色念珠菌，\n\n08:09.804 --> 08:12.429\n它的株数是228株啊，\n\n08:12.429 --> 08:14.279\n占比是61%。\n\n08:14.480 --> 08:18.268\n热带念珠菌占比是21%，\n\n08:18.268 --> 08:20.105\n光滑念珠菌啊，\n\n08:20.105 --> 08:21.454\n株数是22种，\n\n08:21.454 --> 08:22.730\n占比是6%。\n\n08:22.880 --> 08:23.429\n那么，\n\n08:23.429 --> 08:24.779\n这个我们看一下，\n\n08:24.779 --> 08:26.480\n还有克柔念珠菌，\n\n08:26.579 --> 08:29.179\n近平滑念珠菌记忆。\n\n08:29.260 --> 08:30.709\n念珠菌等等。\n\n08:31.661 --> 08:31.911\n那么，\n\n08:31.911 --> 08:35.736\n开始进行抗真菌治疗的条件是什么呢？\n\n08:35.736 --> 08:36.086\n第一，\n\n08:36.086 --> 08:37.411\n要具备，\n\n08:37.411 --> 08:40.161\n患者具备有发生真菌感染的危险因素。\n\n08:40.262 --> 08:40.812\n第二，\n\n08:40.812 --> 08:44.062\n具备有真菌感染的临床表现和体征。\n\n08:44.211 --> 08:44.812\n第三，\n\n08:45.012 --> 08:46.986\n具备真菌定植的证据。\n\n08:46.986 --> 08:47.512\n第四，\n\n08:47.711 --> 08:52.062\n我们要要达到了早期经验性抗真菌治疗的标准。\n\n08:53.210 --> 08:53.409\n嗯，\n\n08:53.659 --> 08:56.284\n经验性抗真菌这个治疗的合理性，\n\n08:56.284 --> 08:56.684\n第一，\n\n08:56.684 --> 08:59.635\n念珠菌在高危病人中发生率高。\n\n08:59.635 --> 09:00.210\n第二，\n\n09:00.210 --> 09:03.409\n正直在预防侵袭性感染方面有很重要。\n\n09:03.409 --> 09:03.859\n第三，\n\n09:03.960 --> 09:06.135\n真菌感染的诊断有一定的困难。\n\n09:06.135 --> 09:06.609\n第四，\n\n09:06.859 --> 09:09.385\n延迟治疗可增加患者的死亡率。\n\n09:09.385 --> 09:09.760\n第五，\n\n09:09.760 --> 09:13.210\n经验性应用抗真菌治疗与氟康唑安全性相对较高。\n\n09:14.784 --> 09:17.085\nICU患者开始抗菌菌治疗的临床标准，\n\n09:17.085 --> 09:19.734\n第一是抗细菌治疗是没有效果的，\n\n09:19.734 --> 09:20.335\n第二，\n\n09:20.385 --> 09:25.184\n高危病人同时在大于等于两个部位两次以上。\n\n09:26.169 --> 09:27.419\n找到了真菌菌丝，\n\n09:27.718 --> 09:31.318\n第三血无菌体液培养。\n\n09:32.315 --> 09:37.065\n到真菌是阳性的第四高危病人发生眼内炎，\n\n09:37.166 --> 09:39.616\n眼底有白色毛状渗出物，\n\n09:39.666 --> 09:43.541\n白癜病人发生率可达到百分之九十二九十三。\n\n09:43.541 --> 09:44.741\n在这种情况下，\n\n09:44.741 --> 09:48.065\n我们要进行了经验性的抗真菌治疗。\n\n09:50.656 --> 09:52.630\n抗菌菌药物的应用啊，\n\n09:52.630 --> 09:56.606\n那么目前高效且使用安全的抗菌菌药物仍然很缺乏。\n\n09:56.606 --> 09:59.531\n两性霉素B仍是最有效的，\n\n09:59.531 --> 10:01.306\n然而毒性很大。\n\n10:01.606 --> 10:02.955\n氟胞嘧啶较低，\n\n10:02.955 --> 10:04.856\n有较低的毒性，\n\n10:04.955 --> 10:06.656\n但抗真菌无。\n\n10:07.726 --> 10:08.052\n较窄，\n\n10:08.052 --> 10:10.677\n且真菌易对产生耐药性，\n\n10:10.776 --> 10:16.526\n故常需要与两性霉菌B联合使用治疗深部的真菌病。\n\n10:17.653 --> 10:23.603\n近年来合成的两性霉素脂脂质体既保留了高度的抗真菌药物活性，\n\n10:23.603 --> 10:25.302\n又降低了毒性，\n\n10:25.302 --> 10:29.002\n是一类具有临床发展前途的抗真菌药新制剂。\n\n10:29.726 --> 10:34.101\n那么我们看一下详细的讲一下两性霉素B。\n\n10:34.101 --> 10:36.452\n两性霉素B属于多烯类抗生素，\n\n10:36.452 --> 10:38.377\n包括A或B两组分。\n\n10:38.427 --> 10:40.476\nB分分为抗菌活性，\n\n10:40.476 --> 10:46.377\n因为目前临床上所用的两性霉素B几乎对所有的真菌均有抗。\n\n10:47.273 --> 11:00.697\n菌株活性对本品呈现敏感的真菌有新型隐球菌、皮炎芽生菌、组织胞浆菌属、球孢子菌属、孢子丝菌属、念珠菌属等等。\n\n11:00.697 --> 11:03.572\n部分曲菌属对本品耐药，\n\n11:03.572 --> 11:07.973\n皮肤跟毛发癣菌则大多呈现耐药性。\n\n11:08.697 --> 11:12.997\n它的作用机制是与真菌细胞上的滋醇结合，\n\n11:12.997 --> 11:15.598\n损伤粘膜的通透性、副作用。\n\n11:15.598 --> 11:17.848\n它的肾毒性是非常强的，\n\n11:17.947 --> 11:25.447\n对其他的副反应应该有低血钾、肝坏死、心肌心室颤动跟寒颤、高热、恶心、呕吐等。\n\n11:27.739 --> 11:32.090\n那下面我们看一下吡格类的抗真菌药包括米唑组跟三唑组。\n\n11:32.489 --> 11:37.539\n米唑组包括酮康唑、克霉唑米康唑和益康唑。\n\n11:37.539 --> 11:38.940\n后三种口服吸收差，\n\n11:38.940 --> 11:41.090\n主要是作为局部用药。\n\n11:41.239 --> 11:44.989\n三唑如有氟康唑跟伊曲康唑，\n\n11:45.239 --> 11:48.989\n那么比格类抗菌菌要具有广谱抗真菌作用，\n\n11:48.989 --> 11:52.440\n对深浅部真菌均具有抗真菌活性。\n\n11:52.489 --> 11:55.539\n其作用机制为直接损伤真菌的细胞膜，\n\n11:55.739 --> 11:57.039\n改变其头痛性，\n\n11:57.039 --> 11:57.690\n而是真。\n\n11:58.020 --> 11:58.971\n均死亡。\n\n12:00.080 --> 12:00.205\n那么，\n\n12:00.205 --> 12:02.530\n我们看一下最新的这个伊曲康唑，\n\n12:02.580 --> 12:05.229\n它伊曲康唑属于广谱的抗真菌药，\n\n12:05.229 --> 12:10.530\n对浅部深部真菌感染的病原菌均有抗菌作用。\n\n12:10.679 --> 12:14.330\n伊曲康唑为高度脂溶性化合物，\n\n12:14.429 --> 12:15.429\n与食物可。\n\n12:16.179 --> 12:16.405\n不用，\n\n12:16.405 --> 12:17.755\n并增加药物的吸收。\n\n12:17.755 --> 12:21.530\n肾功能不全时对药物代谢没有明显的影响，\n\n12:21.729 --> 12:24.679\n血液跟腹膜透析不能清除该药。\n\n12:25.723 --> 12:28.223\n伊曲康唑治疗地区流行性真菌病，\n\n12:28.223 --> 12:32.924\n如芽生菌病、组织胞浆菌病、除孢子菌病等等，\n\n12:33.073 --> 12:34.473\n具有良好的疗效，\n\n12:34.523 --> 12:38.773\n其有效率可达80%至百分以上。\n\n12:38.874 --> 12:43.023\n治疗上述感染的剂量为每日200.400mg，\n\n12:43.023 --> 12:47.448\n疗程需要长达6个月至24个月，\n\n12:47.448 --> 12:48.973\n也就是半年到两年。\n\n12:51.291 --> 12:52.716\n伊曲康唑治疗条件，\n\n12:52.716 --> 12:54.716\n致病真菌感染的临床资料，\n\n12:54.716 --> 12:56.491\n影片上没有。\n\n12:57.898 --> 12:59.997\n具体的定论由作者报道。\n\n12:59.997 --> 13:07.697\n该药治疗曲菌病的成功率是有从3%、39.70%不等，\n\n13:07.898 --> 13:12.098\n疗效与感染部位及患者的基础疾病有关系。\n\n13:13.010 --> 13:18.536\n伊曲康唑除了治疗皮肤黏膜念珠菌感染有效外，\n\n13:18.536 --> 13:23.760\n对其他部位的念珠菌感染隐球菌感染的治疗效经验尚缺乏。\n\n13:23.960 --> 13:26.560\n由于该药在尿中的活性成分甚少，\n\n13:26.611 --> 13:27.911\n因此啊，\n\n13:27.911 --> 13:32.411\n伊曲康唑不能用于治疗念珠菌所致的尿路感染。\n\n13:33.312 --> 13:33.411\n那么，\n\n13:33.411 --> 13:34.461\n我们看一下氟康唑，\n\n13:34.461 --> 13:35.562\n氟康唑是个老药。\n\n13:35.661 --> 13:38.411\n那么氟康唑具有广谱的抗真菌作用，\n\n13:38.411 --> 13:42.187\n其体外抗菌活性明显低于酮康唑，\n\n13:42.187 --> 13:46.637\n包括白色念珠菌等念珠菌属、隐球菌属等等。\n\n13:46.637 --> 13:51.736\n核康唑的体内抗菌抗菌活性则明显高于体外啊，\n\n13:51.736 --> 13:55.012\n曲菌属多对其呈现耐药性。\n\n13:55.575 --> 14:03.224\n治疗念珠菌属、隐球菌属、球孢子菌属等等所致的动物感染模型具有良好的疗效。\n\n14:04.187 --> 14:05.062\n口服氟康唑后，\n\n14:05.062 --> 14:05.812\n吸收完全，\n\n14:05.812 --> 14:08.486\n可吸收给予药量的90%以上，\n\n14:08.486 --> 14:15.086\n在皮肤水泡液、腹腔液、痰液中浓度可达到了血药浓度的1.2倍，\n\n14:15.336 --> 14:16.486\n在脑积液中，\n\n14:16.486 --> 14:19.137\n药物浓度可达血药浓度的60%，\n\n14:19.486 --> 14:21.437\n脑膜炎症时可能更高。\n\n14:21.437 --> 14:23.836\n可药主要通过肾小球滤过，\n\n14:23.937 --> 14:25.986\n以药物原形自尿中排出，\n\n14:26.086 --> 14:28.036\n肾功能减退时明显延长。\n\n14:29.245 --> 14:33.245\n氟康唑的不良反应发生率约有10%.16%，\n\n14:33.245 --> 14:38.020\n主要为恶心、头痛、皮疹、腹痛、呕吐和腹泻等反应，\n\n14:38.020 --> 14:39.245\n一般反应轻微，\n\n14:39.395 --> 14:40.770\n患者多可耐受，\n\n14:40.770 --> 14:44.245\n仅15%的患者需终止治疗。\n\n14:44.937 --> 14:46.763\n那么抗真菌药物的新进展，\n\n14:46.763 --> 14:51.237\n我们看一下目前在研的抗真菌药物主要有第二代。\n\n14:52.119 --> 14:54.919\n三唑类药物已进行进入了临床实验，\n\n14:55.020 --> 14:58.369\n另一种称谓叫一诺，\n\n14:59.169 --> 15:01.469\n嗯也在研究治疗中。\n\n15:01.619 --> 15:04.645\n那么还有一个第二代三唑类的药物，\n\n15:04.645 --> 15:06.570\n它的主要的特点是什么？\n\n15:06.570 --> 15:11.070\n它说实验实验动物中对免疫功能缺陷的患者仍然有效，\n\n15:11.270 --> 15:16.770\n抗菌谱较上市的三唑类药物是更加广口服。\n\n15:17.619 --> 15:19.119\n后生物利用度较好，\n\n15:19.119 --> 15:21.718\n对某些真菌有杀菌的作用。\n\n15:22.518 --> 15:25.918\n那么这第三、第二代的三唑类主要是氟利康唑，\n\n15:25.918 --> 15:26.918\n为广谱的。\n\n15:27.716 --> 15:37.567\n抗真菌药对曲霉菌、念珠菌、隐球菌、皮炎皮炎、芽生菌、孢子菌等都有明显的良好的作用。\n\n15:37.567 --> 15:40.291\n本品对曲霉菌属具有杀菌作用，\n\n15:40.291 --> 15:42.966\n对念珠菌跟隐球菌的作用优于氟康唑。\n\n15:43.937 --> 15:45.762\n但是它有一定的不良反应，\n\n15:45.762 --> 15:47.562\n有比方说偶有视力障碍，\n\n15:47.562 --> 15:47.937\n皮疹，\n\n15:47.937 --> 15:48.736\n肝损伤等。\n\n15:50.330 --> 15:50.406\n嗯，\n\n15:50.406 --> 15:52.931\n另外还有一个叫h hands，\n\n15:52.981 --> 15:58.281\n主要是抑制真菌细胞壁的贝塔一三D葡萄糖合成酶，\n\n15:58.281 --> 16:00.231\n抑制真菌细胞壁合成，\n\n16:00.231 --> 16:01.481\n对多数真菌有效，\n\n16:01.531 --> 16:04.931\n但对隐球菌跟毛孢子菌是无效的。\n\n16:04.931 --> 16:06.781\n尚未上尚未上市。\n\n16:07.557 --> 16:08.232\n那么小结一下，\n\n16:08.232 --> 16:10.208\n就是抗菌药物种类繁多，\n\n16:10.208 --> 16:14.708\n肺部感染抗菌药物的选用易区分为CIP跟HIP，\n\n16:14.757 --> 16:18.208\n以及本地区流行病学的资料进行选择。\n\n16:18.208 --> 16:20.408\nCIP以格兰氏阳性菌为主，\n\n16:20.408 --> 16:23.458\n而HIP以格兰氏阴性菌跟耐药菌感染为主。\n\n16:23.921 --> 16:28.921\n根据病情轻重选择单药或联药联药联用药物治疗。\n\n16:29.768 --> 16:30.742\n肺炎一旦确诊，\n\n16:30.742 --> 16:33.093\n应尽早选用合适的抗生素进行治疗，\n\n16:33.093 --> 16:38.168\n长期应用皮糖、皮质激素、抗生素跟免疫力低下的患者，\n\n16:38.168 --> 16:40.617\n应考虑真菌感染的可能性。\n\n","v0247cg10004d60smkqljht12nupebh0",1021,683,"2026-01-24 22:22:04","免疫功能低下患者肺部感染的药物选择指南 | 专业用药建议  \n","免疫功能低下, 肺部感染, 药物选择, 抗生素治疗, 免疫抑制患者, 真菌感染治疗, 病毒感染用药, 机会性感染  \n","本文提供免疫功能低下患者肺部感染的药物选择指南，涵盖细菌、真菌和病毒感染的针对性用药建议，帮助医疗专业人员和患者家属了解治疗方案及注意事项。","2026-02-24 13:00:00",[37],{"menuId":38,"menuName":39,"parentId":17,"orderNum":40,"path":41,"component":42,"isFrame":43,"isCache":44,"menuType":45,"visible":26,"status":17,"createDept":6,"remark":24,"createTime":46,"children":47,"columnImage":48,"columnLogo":49,"uncheckedLogo":6,"checkedLogo":6,"isHot":17,"isHome":17,"forceLogin":17,"color":6,"seoTitle":50,"seoKeywords":51,"seoDescription":52,"contentNum":6,"promotionalPoster":53,"menuFrame":7,"innerLink":7,"parentView":7,"routeName":54,"routerPath":41,"componentInfo":42},"1986622624134549505","科普视频",3,"video","/video.html","1","0","T","2025-11-07 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