天津医药

天津医药 ›› 2019, Vol. 47 ›› Issue (4): 365-367.doi: 10.11958/20190583

• 讲座 • 上一篇    下一篇

两性霉素 B经支气管镜肺部局部注入的理论依据和操作流程

冯靖 1，吴波 2，张静 3，李彩丽 1   

  1. 1天津医科大学总医院呼吸与危重症医学科（邮编 300052）；2无锡市第一人民医院移植科；3复旦大学附属上海中山医院呼吸 与危重症医学科
  • 收稿日期:2019-03-01 修回日期:2019-03-23 出版日期:2019-04-15 发布日期:2019-05-27
  • 通讯作者: 冯靖 E-mail:zyyhxkfj@126.com
  • 作者简介:冯靖（1973），男，博士，主任医师，教授，主要从事睡眠呼吸暂停低通气综合征、慢性阻塞性肺疾病、介入呼吸病学方面研究

The theoretical basis and operational procedure of local instillation of amphotericin B into lungs by bronchoscopy

FENG Jing1, WU Bo2, ZHANG Jing3, LI Cai-li1   

  1. 1 Department of Respiratory and Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin 300052, China; 2 Department of Pulmonary Critical Care Medicine, Lung Transplantation Group, Wuxi People’s Hospital; 3 Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Shanghai Medical College, Fudan University
  • Received:2019-03-01 Revised:2019-03-23 Published:2019-04-15 Online:2019-05-27
  • Contact: FENG Jing E-mail:zyyhxkfj@126.com

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摘要： 肺部真菌感染播散迅速，需药物及时干预。短期内即可形成组织坏死及肺局部结构性毁损，经有效抗真 菌药物控制或经患者自身免疫局限后，可迅速形成纤维及肉芽组织包裹。两性霉素 B是多烯类抗真菌药，抗真菌谱 广且作用较强。经静脉应用时，常用治疗量在肺部所达到的药物浓度对真菌仅具有抑菌作用，毒性大，不良反应多 见；经气道黏膜吸收少而缓慢，刺激性不强。根据这些特点，两性霉素 B经支气管镜肺部局部注入具有较大优势，值 得临床推广。本文根据指南及临床实际应用经验，就两性霉素 B经支气管镜肺部局部注入的理论依据和操作流程做 详细说明，其中包括两性霉素 B的药理机制、局部应用剂量和溶液浓度以及具体操作方法。

关键词: 两性霉素 B, 支气管镜检查, 肺疾病, 真菌性

Abstract: Pulmonary fungal infections spread rapidly and need timely intervention of medication. Tissue necrosis and local pulmonary structural damage occur in a short period of time. If fungal infections are controlled by effective antifungal drugs or limited by the patient's autoimmune system, fibrous connective tissue and granulation tissue can be formed quickly. Amphotericin B is a polyene antifungal agent with a wide antifungal spectrum and strong effect. When intravenously applied， the concentration of amphotericin B commonly attained in lungs has only bacteriostatic effect on fungus, with high toxicity and adverse reactions. The absorption through the airway mucosa is low and slow and the irritation is not strong. According to these characteristics, local injection of amphotericin B via bronchoscopy has a great advantage, which is worthy of clinical promotion. Based on the guidelines and clinical experience, the theoretical basis and operation procedure of local instillation of amphotericin B into lungs by bronchoscopy are described in detail，including pharmacological mechanism, local dose, solution concentration and the detailed method of operation of it.

Key words: amphotericin B, bronchoscopy, lung diseases, fungal