新生儿万古霉素群体药动学模型建立的必要性评价

发布时间：2018-10-05 21:22

【摘要】：目的:观察研究万古霉素在新生儿中的临床应用及血药谷浓度达标情况,评价新生儿万古霉素群体药动学模型建立的必要性。方法:回顾性收集苏州市立医院本部新生儿科2011年7月-2014年8月使用万古霉素的病史材料,对其感染部位、病原学检查、疗程、疗效、合并用药、血药浓度监测结果进行统计与分析。结果:入选71例患儿,90.14%为多部位混合感染,最常见的是呼吸道合并血流感染(43.66%);病原学送检率100%,首次培养阳性率80.28%,以葡萄球菌属为主(87.67%);万古霉素首次用药后血药谷浓度达标(10~20 mg·L-1)率28.17%,未达标患者中有43.14%进行剂量调整,调整后达标率50%;万古霉素总临床有效率为90.14%,血药谷浓度未达标组的临床有效率为42.25%,达标组有效率为47.62%;首次经验性用药未进行剂量调整组万古霉素疗程为(13.41±4.41)d,经验性剂量调整组为(18.73±9.52)d(P=0.001 88)。结论:万古霉素治疗新生儿感染疗效确切,但经验性用药后血药谷浓度达标率低,未达标者临床疗效差,经验性多次调整万古霉素用法显著延长患儿治疗时间,因此有必要建立新生儿万古霉素群体药动学模型以实现个体化给药治疗。
[Abstract]:Objective: to observe the clinical application of vancomycin in neonates and to evaluate the necessity of establishing a colony pharmacokinetic model of vancomycin. Methods: the history of vancomycin was collected retrospectively from July 2011 to August 2014 in pediatrics department of Suzhou Municipal Hospital. The infection site, etiological examination, course of treatment, curative effect and combined use of vancomycin were analyzed. The results of blood drug concentration monitoring were analyzed. Results: among 71 children, 90.14% of them were multisite mixed infection. The most common cases were respiratory tract complicated with blood flow infection (43.66%), the rate of etiological examination was 100, the positive rate of the first culture was 80.28%, Staphylococcus was the main group (87.67%), the concentration of vancomycin reached the standard of 10 ~ 20 mg ~ (-1) (10 ~ 20 mg 路L ~ (-1) and the dosage adjustment was made in 43.14% of the patients. The total clinical effective rate of vancomycin was 90.14, the clinical effective rate of substandard group was 42.25, and the effective rate of standard group was 47.62.The course of vancomycin was (13.41 卤4.41) days in the first empirical group without dose adjustment. The dose adjusted group was (18.73 卤9.52) d (P0. 001 88). Conclusion: vancomycin is effective in the treatment of neonatal infection, but the serum concentration of vancomycin is low after experiential treatment, and the clinical efficacy of those who fail to reach the standard is poor. The treatment time of patients with infantile infection can be prolonged by adjusting vancomycin for many times. Therefore, it is necessary to establish a colony pharmacokinetic model of vancomycin in neonates to realize individualized administration of vancomycin.
【作者单位】：南京医科大学附属苏州医院药学部;南京医科大学附属苏州医院新生儿科;
【基金】：苏州市科技发展计划项目(编号:SYSD2014148)
【分类号】：R969.1

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