米卡芬净联合连续性肾脏替代治疗在脓毒症伴真菌感染患者中的应用效果

Clinical outcomes of micafungin combined with continuous renal replacement therapy in patients with sepsis and concomitant fungal infection

摘要:

目的 探究米卡芬净联合连续性肾脏替代治疗（CRRT）在脓毒症伴真菌感染患者中的应用效果。方法 选取2023年6月—2025年6月中国人民解放军联勤保障部队第九一〇医院100例脓毒症伴真菌感染患者，按照治疗方法不同分为氟康唑组（53例）与米卡芬净组（47例）。氟康唑组给予氟康唑联合CRRT治疗；米卡芬净组给予米卡芬净联合CRRT治疗。比较两组的脏器功能、血流动力学、炎症因子、预后指标及生存情况。结果 治疗后，米卡芬净组的总胆红素、血肌酐、序贯器官衰竭评估评分、急性生理与慢性健康评分Ⅱ均低于氟康唑组（P <0.05）；米卡芬净组的平均动脉压高于氟康唑组，心率、乳酸均低于氟康唑组（P <0.05）；米卡芬净组的C反应蛋白、降钙素原、白细胞介素-6均低于氟康唑组（P <0.05）。米卡芬净组重症监护病房住院时间短于氟康唑组（P <0.05）；两组的7 d、28 d病死率比较，差异均无统计学意义（P >0.05）。两组总存活率比较，差异无统计学意义（P >0.05）。结论 米卡芬净联合CRRT在脓毒症伴真菌感染患者中的应用效果较为显著。

Abstract:

Objective To investigate the clinical effects of micafungin combined with continuous renal replacement therapy (CRRT) in patients with sepsis complicated by fungal infection.Methods A total of 100 patients with sepsis complicated by fungal infection who were admitted to The 910th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army from June 2023 to June 2025 were enrolled. According to the treatment received, the patients were divided into a fluconazole group (n = 53) and a micafungin group (n = 47). The fluconazole group received fluconazole combined with CRRT, whereas the micafungin group received micafungin combined with CRRT. Organ function, hemodynamic indices, inflammatory factors, prognostic indicators, and survival were compared between the two groups.Results After treatment, the total bilirubin (TBil) and serum creatinine (Scr) levels and the Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores were lower in the micafungin group than in the fluconazole group (P < 0.05). Mean arterial pressure (MAP) was higher, whereas heart rate (HR) and lactate (Lac) levels were lower in the micafungin group (P < 0.05). The levels of C-reactive protein (CRP), procalcitonin (PCT), and interleukin-6 (IL-6) were lower in the micafungin group than in the fluconazole group (P < 0.05). The intensive care unit (ICU) stay was shorter in the micafungin group (P < 0.05). No statistically significant differences were observed between the two groups in the 7-day or 28-day mortality rate or the overall survival rate (P > 0.05).Conclusion Micafungin combined with CRRT has favorable clinical effects in patients with sepsis complicated by fungal infection.