199例住院患儿万古霉素临床应用调查

发布时间：2018-03-02 16:14

本文选题：儿科　切入点：万古霉素　出处：《重庆医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：随着万古霉素临床应用的日益广泛，现已产生了万古霉素耐药菌株，正确认识并合理应用万古霉素具有重要的临床意义与价值。本调查通过了解我院儿童万古霉素的临床应用情况，分析其用药现状及用药合理性，为进一步促进万古霉素在儿童临床合理应用提供理论依据及参考。方法：回顾性收集我院2012年6月份到2012年11月份6个月住院患儿的万古霉素用药临床资料，包括患儿一般情况、临床诊断、病原学检查、用药剂量、疗程、血药浓度监测、用药合理性、药物不良反应等进行相关统计分析。结果：（1）199例使用万古霉素患儿包括儿内科患儿150例和儿外科患儿49例。平均住院天数为78天，最短住院天数为1天，最长住院天数为150天。年龄分布以小于1岁婴儿为主，占55%，其次为幼儿，占17%。（2）临床诊断以肺炎及败血症多见，占66%。（3）199例患儿中有194例进行了病原学检查，标本主要来自无菌腔标本，占72.68%。阳性标本145例，占74.74%，阴性49例，占25.26%。阳性标本以金黄色葡萄球菌最多见，共35例，，占24.14%，其次为表皮葡萄球菌，共19例，占13.10%。（4）行药物敏感性实验的145例标本明确有83例对万古霉素敏感，余未行万古霉素药敏实验。（5）每天用万古霉素总剂量最多的为40mg/kg，占49%；用药频次最多的为q6h，占54%；199例中有84例行血药浓度监测。199例病例中有96例联合使用抗菌药物，占48.24%。（6）临床疗效以有效为主，占44.22%，199例中发生不良反应的有6例，占3.02%，主要的不良反应为皮疹。结论：总体来讲，万古霉素在我院儿科的应用基本合理，我院临床重视万古霉素使用前的病原学证据寻找，并根据病原学特点开展治疗，我院对万古霉素不良反应的监测较严密。但同时我院使用万古霉素也存在不足之处，应进一步加强用药前的万古霉素药敏实验检查。万古霉素具有严重的肾、耳毒性，用药疗程要求严格，应合理控制万古霉素的用药疗程，并严格掌握联合抗生素的应用指征。万古霉素的血药浓度受到多种因素的影响，如疾病的严重程度，肥胖，肾功能等，我院应注意万古霉素的初始使用剂量，并监测血药浓度及时调整用药剂量，同时应严格适应症，进一步规范万古霉素的使用，有助于提高万古霉素的治疗效果、合理用药水平及防范不良反应。
[Abstract]:Objective: with the increasing clinical application of vancomycin, vancomycin resistant strains have been produced. The correct understanding and rational application of vancomycin is of great clinical significance and value. Through understanding the clinical application of vancomycin in children in our hospital, the present situation and rationality of vancomycin use are analyzed. To further promote the clinical application of vancomycin in children to provide theoretical basis and reference. Methods: the clinical data of vancomycin used in our hospital from June 2012 to November 2012 were collected retrospectively, including general situation, clinical diagnosis, etiological examination, dosage, course of treatment and monitoring of serum drug concentration. The rationality of drug use and adverse drug reactions were statistically analyzed. Results among 199 cases of vancomycin, 150 cases were children in pediatric medicine and 49 cases in pediatric surgery. The average hospitalization days were 78 days, the shortest hospitalization days were 1 day, and the longest hospitalization days were 150 days. The age distribution was mainly for infants under 1 year old. Pneumonia and septicemia were more common in clinical diagnosis. 194 out of 66.1,199 cases were examined by etiology. The samples were mainly from aseptic cavity, accounting for 72.68.The positive specimens were 145 cases, accounted for 74.74 cases, and negative cases were 49 cases. Staphylococcus aureus was the most common positive specimen, accounting for 24.14, followed by Staphylococcus epidermidis (19 cases). The total dose of vancomycin was 40 mg / kg per day (49%), and the most frequently used vancomycin was Q6 h (84 out of 54199 cases) and 96 of 199 cases (96 cases of combined use of antimicrobial agents). The clinical curative effect was mainly effective, accounting for 6 cases (3.02%) in 199 cases of 44.22 cases. The main adverse reaction was rash. Conclusion: in general, the application of vancomycin in pediatrics of our hospital is basically reasonable. Our hospital attaches importance to the search of etiological evidence before the use of vancomycin, and carries out treatment according to the characteristics of etiology. The adverse reactions of vancomycin were closely monitored in our hospital. However, there were some deficiencies in the use of vancomycin in our hospital, so we should further strengthen the test of vancomycin sensitivity before taking vancomycin. Vancomycin has severe renal and ototoxicity. The course of treatment should be strictly controlled and the indication of application of combined antibiotics should be strictly grasped. The concentration of vancomycin in blood is affected by many factors, such as the severity of disease, obesity, renal function, etc. Our hospital should pay attention to the initial dosage of vancomycin, monitor the concentration of vancomycin and adjust the dosage of vancomycin in time. At the same time, we should strictly regulate the use of vancomycin in order to improve the therapeutic effect of vancomycin. Level of rational use of drugs and prevention of adverse reactions.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R725

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