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目的:了解耳真菌病的致病菌种及其药物敏感性,进而探讨有效的治疗方法。方法:从325例本病患者中随机选出的110例进行真菌培养及菌种鉴定。用Etest技术,以酮康唑(KE)、伊曲康唑(IT)、氟康唑(FC)、氟胞嘧啶(FL)及二性霉素B(AP)5种药物试条进行药敏测试。将325例患者随机分4组,分别用复方达克宁霜、酮康唑霜、克霉唑软膏及麝香草酚酒精作局部治疗;对局部治疗无效的30例,用IT作间歇冲击治疗。结果:致病真菌培养阳性率为91%。致病真菌分布主要为曲霉菌(79%)、白色念珠菌(8%)及桔青霉菌(5%)。曲霉菌对KE,IT敏感,对FC和FL耐药;白色念珠菌对5种抗真菌药均敏感;桔青霉菌对AP,FC,KE敏感,对FC耐药。局部用药有效率4组分别为97.6%、97.5%、90.0%和80.0%,复方唑类与醑类药有效率的比较有显著差异(P<0.05)。对局部用药无效的30例,全身用IT间歇冲击治疗,100%有效。结论:耳真菌病的致病菌是以曲霉菌、白色念珠菌、桔青霉菌为主;复方唑类药局部治疗效果比醑类药为佳。局部用药无效者应全身用IT间歇冲击治疗。
Objective: To understand the pathogens of ear fungal disease and its drug sensitivity, and then explore effective treatment. Methods: One hundred and thirteen randomly selected patients from 325 patients were tested for fungal culture and strain identification. Using Etest technology, drug susceptibility test was conducted with five drug test strips of ketoconazole (KE), itraconazole (IT), fluconazole (FC), flucytosine (FL) and amphotericin B test. 325 patients were randomly divided into 4 groups, respectively, with compound deflux cream, ketoconazole cream, clotrimazole ointment and thymol alcohol for local treatment; local treatment ineffective in 30 cases, with IT for intermittent impact treatment. Results: The positive rate of pathogenic fungi culture was 91%. Pathogenic fungi are mainly Aspergillus (79%), Candida albicans (8%) and Penicillium citrinum (5%). Aspergillus was susceptible to KE, IT and resistant to FC and FL. Candida albicans was sensitive to all 5 antifungal agents. Penicillium citrinum was sensitive to AP, FC and KE and resistant to FC. The effective rate of topical administration was 97.6%, 97.5%, 90.0% and 80.0% respectively in 4 groups. There was significant difference between the effective rate of compound azole and the class of drugs (P <0.05). 30 cases of local drug ineffective, the whole body with IT intermittent impact treatment, 100% effective. Conclusion: The pathogenic bacteria of ear fungus are mainly Aspergillus, Candida albicans and Penicillium citrinum. The local treatment effect of compound azole is better than that of 醑 drugs. Local drug ineffective body should be treated with IT intermittent impact.