极重度骨髓型和肠型急性放射病合并真菌感染的临床治疗

目的研究探讨极重度骨髓型放射病和肠型放射病合并真菌感染的诊治经验。方法2004年10月24日收治极重度骨髓型放射病和肠型放射病两例患者，行HIA相合及半相合造血干细胞移植成功并顺利恢复造血。病程中2例均反复并发严重的多部位、多种类真菌感染。结果采用联合抗真菌治疗及对症支持，病例A效果不好，病例B真菌明显控制，但2例最终死于急性放射病、严重感染及多脏器衰竭。结论真菌感染是放射病严重的合并症，多药联合抗真菌治疗放射病合并严重真菌感染，治疗有效，未见明显毒性增加，值得借鉴。

Management of two patients with intestinal form of acute radiation sickness and extremely severe bone marrow form of acute radiation sickness complicated with disseminated fungous infection

Objective To present two patients diagnosed as intestinal form of acute radiation sickness (patient A) and extremely severe bone marrow form of acute radiation sickness(patient B) complicated with disseminated fungous infection in China. Methods On October 21st, 2004, a nuclear accident occurred in Jining, Shandong Province, China. Two individuals were accidentally irradiated by a ~ 60 Co source. They were transferred to our hospital, and performed allogeneic stem cell transplantation and soon acquired hematopoisis recovery; however, refractory disseminated fungous infection occurred in two patients. Results High dosage of amphotericin B combined with itraconazole and concidas were used to kill fungi. The infection was once controlled, but the radiation injury and infection were still becoming worse even after many kinds of treatment. The patients finally died of multiple organ failure on day 33 and day 75, respectively after the accident. Conclusions The combination of Ampghotec (amphotericin B) with Caspofungin(concidas) and Itraconazole in the treatment of disseminated fungous infection was effective and with no related toxicity. But during the continuous injury of radiation, we couldn't eradicate the fungous infection. The patients were finally died of multiple organs failure related with radiation and infection.