革兰阳性球菌重症肺炎患儿万古霉素血药谷浓度影响因素分析

发布时间：2018-03-16 23:09

  本文选题：重症肺炎　切入点：万古霉素　出处：《临床儿科杂志》2017年06期 　论文类型：期刊论文

【摘要】：目的探讨革兰阳性球菌重症肺炎患儿万古霉素血药谷浓度的影响因素。方法收集93例革兰阳性球菌重症肺炎患儿的一般情况、生化检查结果及万古霉素血药浓度,回顾分析患儿临床资料中与万古霉素血药谷浓度相关的因素。结果在万古霉素40~60 mg/(kg·d)的给药方案下,93例革兰阳性球菌重症肺炎患儿中万古霉素血药谷浓度10 mg/L 54例、10~mg/L 26例、≥20 mg/L 13例,三组间谷氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、肾小球滤过率(GFR)和谷酰转肽酶(γ-GT)水平差异有统计学意义(P均0.05),其中10~mg/L组的AST和γ-GT最高,≥20 mg/L组ALT最高而GFR最低。多重线性回归分析发现,GFR与万古霉素血药谷浓度间存在负线性相关关系(R~2=0.039,P0.05)。GFR≥90 m L/(min·1.73 m~2)、60≤GFR≤89 m L/(min·1.73 m~2)、30≤GFR≤59 m L/(min·1.73 m~2)组患儿对应万古霉素血药谷浓度中位数分别为8.7 mg/L、18.2 mg/L、6.5 mg/L,差异有统计学意义(P均0.05)。结论革兰阳性球菌重症肺炎患儿万古霉素血药谷浓度与GFR水平呈负相关,合并肾功能轻度损害者更易达到万古霉素目标血药谷浓度值。临床上应以指南推荐的较低剂量使用万古霉素,并注意密切监测其血药谷浓度。
[Abstract]:Objective to investigate the influencing factors of serum vancomycin concentration in children with Gram-positive cocci severe pneumonia. Methods 93 cases of Gram-positive cocci severe pneumonia were collected, the results of biochemical examination and the concentration of vancomycin were collected. Results the clinical data of 93 children with severe pneumonia of Gram positive cocci were treated with vancomycin 4060 mg/(kg 路d. Results the serum concentration of vancomycin was 10 mg/L or 10 mg / L in 54 patients with severe pneumonia of Gram positive cocci. There were significant differences in the levels of glutamate aminotransferase (alt), aspartate aminotransferase (AST), glomerular filtration rate (GFR) and glutenyl transpeptidase (纬 -GTase) between the three groups (P < 0.05), and the highest levels of AST and 纬 -GT were found in 10 mg / L group. The ALT of 鈮，

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