| 姜孙旻,徐银莹,陆子红,等.早产儿万古霉素治疗 34例药物监测与用药分析[J].安徽医药,2020,24(10):2104-2108. |
| 早产儿万古霉素治疗 34例药物监测与用药分析 |
| Therapeutic drug monitoring and medication analysis of 34 cases of vancomycin in premature infants |
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| DOI：10.3969/j.issn.1009?6469.2020.10.047 |
| 中文关键词: 药物监测 药物疗法管理 临床药师 万古霉素 婴儿，早产 |
| 英文关键词: Drug monitoring Medication therapy management Clinical pharmacist Vancomycin Infant,premature |
| 基金项目:江苏省妇幼保健资助项目(F201639)；无锡市卫计委科研青年项目(Q201603)；无锡市卫计委“科教强卫工程”青年医学人才项目 |
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| 中文摘要: |
| 目的评估万古霉素早产儿治疗药物监测(Therapeutic Drug Monitoring，TDM)及用药情况，分析万古霉素在早产儿重症感染治疗过程中进行 TDM的必要性。方法采用回顾性分析方法，制定相应标准，按标准收集 2016—2018年南京医科大学附属无锡妇幼保健院早产儿 34例，统计分析其基本情况、血培养、痰培养等相关病原学检查、药敏试验结果、血药浓度结果、化验室指标、药物疗效及药品不良反应(Adverse Drug Reaction，ADR)等结果。结果统计分析的 34例病儿中，诊断以新生儿脓毒血症为主(48.94%)病原学送检率 100%，阳性检出率 76.47%，22例(占 83.33%)为革兰阳性菌感染，药敏试验结果均显示对万古霉素敏感；监测范围10～20 μg/mL的初次血药谷浓度病儿极少(仅占 26.47%)，而通过临床药师合理干预可大大提高谷浓度的达标率(占 在，76.92%)差异有统计学意义(P＜0.05)。经万古霉素治疗后有效率达 85.29%，复查病儿的各项指标较前有明显好转［降钙素原(PCT)为.86±0.28)比(0.31±0.43)ng/mL，尿素(Urea)(5.39±3.91)比(2.24±1.35)mmol/L，血肌酐(Cr)为(64.24±20.44)比(34.43± (0，9.82)μmol/L，胱抑素C(CysC)为(1.85±0.55)比(1.29±08)mg/L、天冬氨酸氨基转移酶(AST)为(43.72±25.03)比(25.03±11.01)IU/ L，均P＜0.05］；未检测到万古霉素引起的耳肾损害等 ADR。结论万古霉素治疗早产儿感染，特别是革兰阳性菌引起的重症感.2为染效果明确。进行 TDM可以实现早产儿万古霉素治疗个体化，使早产儿用药更加安全有效。 |
| 英文摘要: |
| Objective To evaluate the therapeutic drug monitoring(TDM)and the medicatiom application of vancomycin in prema? ture infants，and analyze the necessity of using vancomycin in the treatment of severe infection in premature infants.Methods Ret? rospective analysis method was used to establish the corresponding standards.According to the standard，34 cases of premature in?fants in Wuxi Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University from 2016 to 2018 were collected.The basic information，blood culture，sputum culture and other related etiological examination，drug sensitivity test results，blood drug concentration results，laboratory indicators，drug efficacy and adverse drug reaction(ADR)results were statistically analyzed. Results Among the 34 cases，most of them were diagnosed as neonatal sepsis(48.94%).All cases received etiological examina? tion，and 76.47% showed positive.Among them，22 cases(83.33%)were Gram?positive bacteria infection.The results of drug sensi?tivity test were all sensitive to vancomycin.Only 26.47% cases were monitored within the range of 10?20 μg/mLin initial blood drugvalley concentrations，and the compliance rate of valley concentrations could be greatly improved by reasonable intervention of clini? cal pharmacists(76.92%，P＜0.05).After vancomycin treatment，the effective rate reached 85.29%.During the re?examination，the indicators were significantly better than before［PCT(0.86±0.28)vs.(0.31±0.43)ng/mL，Urea(5.39±3.91)vs.(2.24±1.35)mmol/L，Cr |
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