儿童重症监护室中患儿万古霉素的治疗药物浓度监测及其药动学特征

发布时间：2018-05-27 19:28

本文选题：万古霉素 + 重症监护病房　；参考：《中国新药与临床杂志》2015年02期

【摘要】：目的了解儿童重症监护室(PICU)中使用万古霉素患儿的血药浓度及其药动学参数分布情况,并初步判断目前的药物推荐剂量是否能够达到理想治疗浓度。方法入选接受万古霉素治疗的患儿60例(男性41例,女性19例),用药剂量为(39.99±4.42)mg·kg-1·d-1。采用酶免疫放大法进行血药浓度测定,血药浓度数据采用一室模型拟合,根据Sawchuk-Zaske方法计算患儿的主要药动学参数,并将所得结果数据和药品说明书参数以及过往儿童药动学研究数据相比较,同时对2岁以下和以上患儿药动学参数进行比较。结果研究纳入的60例患儿中有30例谷浓度达到了5~15 mg·L-1,只有4例达到15~20 mg·L-1,另有2例超过20 mg·L-1;有6例峰浓度超过了40 mg·L-1。32例患儿的AUC24 h值超过了400 mg·h·L-1。本研究患儿的Vd高于说明书及文献研究结果 (P0.05和P0.01)。2岁以下患儿和2岁以上相比,后者具有更高的消除速度常数[(0.22±0.10)h-1 vs.(0.27±0.09)h-1,P0.05]。结论万古霉素药品说明书推荐的40 mg·kg-1·d-1剂量不足以使所有PICU患儿达到有效的治疗谷浓度,PICU患儿使用万古霉素可能需要更大的负荷剂量。
[Abstract]:Objective to investigate the serum concentration of vancomycin and its pharmacokinetic parameters in children's intensive care unit (ICU), and to determine whether the current recommended dose of vancomycin can reach the ideal therapeutic concentration. Methods 60 children (male 41, female 19) who received vancomycin were enrolled. The dosage of vancomycin was 39.99 卤4.42)mg kg-1 d-1. The serum drug concentration was measured by enzyme immunoamplification method. The blood concentration data were fitted by a one-compartment model. The main pharmacokinetic parameters of the children were calculated according to the Sawchuk-Zaske method. The pharmacokinetic parameters of children under 2 years of age and above were compared with the data of pharmacokinetics of children under 2 years of age and above. Results the valley concentration of 30 of the 60 children in the study was up to 15 ~ 15 mg / L, only 4 of them reached 15 ~ (20) mg 路L ~ (-1), the other two were above 20 mg ~ (-1), and the peak concentration of AUC24 in 6 cases was over 40 mg / L ~ (-1), and the AUC24 h value was more than 400 mg 路L ~ (-1). In this study, the VD of the children was higher than that of the manual and literature study. The latter had a higher elimination rate constant than that of the children under the age of 2 years [0.22 卤0.10)h-1 vs.(0.27 卤0.09 h-1P 0.05]. Conclusion the dosage of 40 mg kg-1 d-1 recommended by vancomycin drug instruction is not enough to make all children with PICU reach the effective therapeutic concentration. The dosage of vancomycin may need to be more loaded in the use of vancomycin in children with vancomycin.
【作者单位】：上海交通大学医学院附属上海儿童医学中心药剂科;上海交通大学医学院附属上海儿童医学中心儿童重症监护室;
【分类号】：R96

【参考文献】