万古霉素不同给药剂量和方法对谷浓度及严重脓毒症临床疗效的影响

发布时间：2018-03-17 23:12

本文选题：万古霉素　切入点：儿科严重脓毒症　出处：《浙江大学》2016年硕士论文　论文类型：学位论文

【摘要】：研究背景：万古霉素属糖肽类抗菌药物,抑制细菌细胞壁的合成。近年来,由于抗生素在临床的广泛应用,其中以耐甲氧西林金黄色葡萄球菌(MRSA)、耐甲氧西林表皮葡萄球菌(MRSE)日渐增多,万古霉素作为重症G+菌感染的首选治疗药物,再次将其推到了抗感染治疗的前沿。但万古霉素的治疗指数窄,个体差异大,影响因素多,且耳、肾毒性大,因此对患者进行药物浓度监测尤为重要。目的：通过万古霉素不同给药剂量及方法分析对血药谷浓度及治疗严重脓毒症临床疗效的影响。方法：采用前瞻性研究方法,将2013年5月-2015年11月浙江大学儿童医院PICU52例确诊革兰氏阳性菌感染儿童严重脓毒症患儿分为3组：A组18例万古霉素15mg/kg/次(q8h),平均年龄为3.40±2.11岁,平均体重13.15±10.13Kg,性别比男：女5：4；B组20例万古霉素首剂30mg/kg后15mg/kg/次(q8h),平均年龄为3.02±2.09岁,平均体重14.27±12.16Kg,性别比男：女11：9；C组14例万古霉素15mg/kg/次(q6h)平均年龄为3.03±2.02岁,平均体重13.78士11.22Kg,性别比男：女1：1。三组在年龄、性别和体重方面没有统计学差异。万古霉素每次给药时间均超过1h。分别于用药4次后、3天、7天于用药前30 min抽血检验,通过酶放大免疫分析法(Emit)测定血液万古霉素谷浓度。用药前查体温、血常规、双份血培养、CRP、PCT、肝肾功能,用药后3天、7天复查(5天复查血培养)。本课题所有内容均告知患儿监护人,并得到其书面知情同意。课题研究方案经过浙江大学医学院附属儿童医院安全委员会讨论,并取得其许可。结果：B组和C组用药4次和3天、7天达有效谷浓度的比例明显高于A组,有统计学意义(P0.05)。B和C两组血培养转阴率、白细胞下降率、体温、PCT、CRP下降均明显早于A组,有统计学意义(P0.05)。肝肾功能变化比较均无统计学意义(P0.05)。结论：通过本文研究提示使用万古霉素药物剂量首剂30mg/kg后15mg/kg/次(q8h)和15mg/kg/次(q6h)比15mg/kg/次(q8h)达有效谷浓度时间早、且疗效优,同时首剂30mg/kg后15mg/kg/次(q8h)疗效略优于15mg/kg/次(q6h)。提示万古霉素谷浓度维持在10-20mg/L谷浓度区间,其临床疗效明显,且无明显肝肾功能损害等毒副作用的发生。
[Abstract]:Background: vancomycin is a glycopeptide antimicrobial agent that inhibits the synthesis of bacterial cell wall. Among them, more and more methicillin-resistant Staphylococcus aureus and methicillin-resistant Staphylococcus epidermidis were used. Vancomycin was the first choice for the treatment of severe G infection. But vancomycin's treatment index is narrow, individual difference is large, influence factor is many, and ototoxicity is great. Therefore, it is very important to monitor the drug concentration in patients. Objective: to analyze the effects of different doses and methods of vancomycin on serum drug concentration and clinical efficacy in the treatment of severe sepsis. From May 2013 to November 2015, PICU52 patients with severe sepsis with Gram-positive bacteria infection were divided into 3 groups: group A: 18 patients with vancomycin 15mg / kg / kg, mean age 3.40 卤2.11 years. The average body weight was 13.15 卤10.13 kg / kg, male: female: group B: female: group B: vancomycin 15 mg / kg after 30 mg / kg, mean age was 3.02 卤2.09 years old, average weight was 14.27 卤12.16 kg, male: female: female 11: 9C group: 14 cases of vancomycin 15mg / kg / kg Q6h) mean age was 3.03 卤2.02 years old. The average body weight was 13.78 卤11.22 kg / g, male: female 1: 1.There was no significant difference in age, sex and body weight among the three groups. Vancomycin was administered for more than 1 hour each time. The concentration of vancomycin in blood was measured by enzyme amplified immunoassay (Emitt). Body temperature, blood routine, double blood culture, CRP PCT, liver and kidney function were examined before medication. All contents of this study were informed to the guardian of the child and their written informed consent was obtained. The project was discussed by the Safety Committee of Children's Hospital affiliated to Zhejiang University Medical College. Results the ratio of effective valley concentration in group B and group C was significantly higher than that in group A for 4 times and 3 days. There was significant difference between group A and group A in the negative rate of blood culture, the decrease rate of white blood cells, the decrease of body temperature and the decrease of serum PCTTnC-reactive protein in group C and group B were significantly earlier than those in group A, and the blood culture negative rate of group B and group C were significantly earlier than those in group A. There was no significant difference in the changes of liver and kidney function between the two groups. Conclusion: the results of this study suggest that the effective valley concentration of vancomycin was earlier than that of 15 mg / kg Q8h after the first dose of vancomycin was 30 mg / kg) and 15 mg / kg / time Q8h), and the effect was better than that of 15 mg / kg Q8h. At the same time, 15 mg / kg after the first dose of 30 mg / kg, the curative effect was slightly better than that of 15 mg / kg / L Q6h. It suggested that the concentration of vancomycin was maintained in the range of 10-20 mg / L valley concentration, and the clinical efficacy was obvious, and there were no obvious side effects such as liver and kidney function damage.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R720.597

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