临床药物治疗杂志
臨床藥物治療雜誌
림상약물치료잡지
CLINICAL MEDICATION JOURNAL
2015年
4期
61-64
,共4页
万古霉素%血药浓度%新生儿%不良反应%疗效
萬古黴素%血藥濃度%新生兒%不良反應%療效
만고매소%혈약농도%신생인%불량반응%료효
vancomycin%blood concentration%neonates%adverse reaction%curative effect
目的:探讨新生儿应用万古霉素行血药浓度监测的意义.方法:选取2012年1月至2014年11月使用万古霉素治疗的住院新生儿174例,采用高效液相色谱(HPLC)法测定患儿万古霉素血药峰浓度和谷浓度,并观察患儿不良反应发生情况.结果:174例患儿中,万古霉素血药谷浓度最低值为2.04 mg?L-1,最高值为13.49 mg?L-1,平均为(6.01±2.18)mg?L-1,峰浓度最低值为9.04 mg?L-1,最高值为50.47 mg?L-1,平均为(32.17±11.08)mg?L-1;有101例患儿血清谷浓度<5 mg?L-1,治疗总有效率为93.07%,不良反应率为16.83%,45例患儿血清谷浓度在5~10 mg?L-1,治疗总有效率为100.00%,不良反应率为16.83%,28例患儿血清谷浓度>10 mg?L-1,治疗总有效率为100.00%,不良反应率为28.57%,3个不同范围血药浓度的治疗疗效和不良反应比较,差异无统计学意义(P>0.05);不良反应主要以肝损害和听力损害为主,其中肝损害发生率为9.20%,听力损害发生率为10.34%;随着万古霉素血清谷浓度增加,不良反应发生率没有趋势性增加(X2=2.032,P=0.154).结论:新生儿应用万古霉素有较高的肝损害和听力损害发生率,临床应用应严格掌握剂量、适应证,在血药浓度监测下行个体化治疗.
目的:探討新生兒應用萬古黴素行血藥濃度鑑測的意義.方法:選取2012年1月至2014年11月使用萬古黴素治療的住院新生兒174例,採用高效液相色譜(HPLC)法測定患兒萬古黴素血藥峰濃度和穀濃度,併觀察患兒不良反應髮生情況.結果:174例患兒中,萬古黴素血藥穀濃度最低值為2.04 mg?L-1,最高值為13.49 mg?L-1,平均為(6.01±2.18)mg?L-1,峰濃度最低值為9.04 mg?L-1,最高值為50.47 mg?L-1,平均為(32.17±11.08)mg?L-1;有101例患兒血清穀濃度<5 mg?L-1,治療總有效率為93.07%,不良反應率為16.83%,45例患兒血清穀濃度在5~10 mg?L-1,治療總有效率為100.00%,不良反應率為16.83%,28例患兒血清穀濃度>10 mg?L-1,治療總有效率為100.00%,不良反應率為28.57%,3箇不同範圍血藥濃度的治療療效和不良反應比較,差異無統計學意義(P>0.05);不良反應主要以肝損害和聽力損害為主,其中肝損害髮生率為9.20%,聽力損害髮生率為10.34%;隨著萬古黴素血清穀濃度增加,不良反應髮生率沒有趨勢性增加(X2=2.032,P=0.154).結論:新生兒應用萬古黴素有較高的肝損害和聽力損害髮生率,臨床應用應嚴格掌握劑量、適應證,在血藥濃度鑑測下行箇體化治療.
목적:탐토신생인응용만고매소행혈약농도감측적의의.방법:선취2012년1월지2014년11월사용만고매소치료적주원신생인174례,채용고효액상색보(HPLC)법측정환인만고매소혈약봉농도화곡농도,병관찰환인불량반응발생정황.결과:174례환인중,만고매소혈약곡농도최저치위2.04 mg?L-1,최고치위13.49 mg?L-1,평균위(6.01±2.18)mg?L-1,봉농도최저치위9.04 mg?L-1,최고치위50.47 mg?L-1,평균위(32.17±11.08)mg?L-1;유101례환인혈청곡농도<5 mg?L-1,치료총유효솔위93.07%,불량반응솔위16.83%,45례환인혈청곡농도재5~10 mg?L-1,치료총유효솔위100.00%,불량반응솔위16.83%,28례환인혈청곡농도>10 mg?L-1,치료총유효솔위100.00%,불량반응솔위28.57%,3개불동범위혈약농도적치료료효화불량반응비교,차이무통계학의의(P>0.05);불량반응주요이간손해화은력손해위주,기중간손해발생솔위9.20%,은력손해발생솔위10.34%;수착만고매소혈청곡농도증가,불량반응발생솔몰유추세성증가(X2=2.032,P=0.154).결론:신생인응용만고매소유교고적간손해화은력손해발생솔,림상응용응엄격장악제량、괄응증,재혈약농도감측하행개체화치료.
Objective:To investigate signiifcance of monitoring of blood concentration of vancomycin for neonates application in neonates.Methods: From January 2012 to November 2014, 174 cases of hospitalized newborns treated by vancomycin were selected. High performance liquid chromatography (HPLC) method was used for the determination of peak plasma concentration and trough concentration of vancomycin in children with the adverse reactions occurrence observed.Results: In 174 cases, the minimum value of trough blood concentration of vancomycin was 2.04 mg?L-1,and the maximum value was 13.49 mg?L-1 with the average of (6.01±2.18) mg?L-1. The minimum value of peak concentration was 9.04 mg?L-1, and the maximum value was 50.47mg?L-1, with average of (32.17±11.08) mg?L-1. There were 101 cases of children with serum trough concentration<5 mg?L-1, the total effective rate 93.07%, and the rate of adverse reaction 16.83%. There were 45 cases of children with serum trough concentration in 5~10 mg?L-1, the total effective rate 100%, and the rate of adverse reaction 16.83%. There were 28 cases of children with serum trough concentration >10 mg?L-1, the total effective rate 100%, and the rate of adverse reaction 28.57%. Efifcacy and adverse reactions among three different blood concentration treatments had no signiifcant difference (P>0.05). The main adverse reactions were liver damage and hearing damage, with liver damage occurrence rate 9.20% and the incidence of hearing damage 10.34%. With the increase of vancomycin serum trough concentrations, the occurrence rate of adverse reaction did not have trend to increase (X2=2.032,P=0.154).Conclusion: The application of vancomycin in neonates had high rate of incidence of liver damage and hearing damage, and the clinical application should be strictly controlled for doseand indications. Individualized treatment with the blood concentration monitoring should be performed.
