阿米卡星耳毒性的预防和监测

Prevention and Monitoring against Amikacin Ototoxicity

目的探讨预防和监测阿米卡星耳毒性的有效措施。方法在146例因手术伤口感染非结核性分枝杆菌而接受长时程阿米卡星治疗的患者中,采用定期监测听力及血药浓度、个体化给药等预防监控措施防范耳毒性,总结评估这些措施的应用情况以及效果。结果146例患者感染伤口均愈合;治疗过程中56例患者出现耳鸣,2例患者出现眩晕和不稳感,及时停药后均恢复正常;5人出现血药谷浓度一过性增高,经调整药量及滴速后迅速恢复正常,均未造成明显内耳功能损害;监测期间所有患者肝肾功能一直正常。结论严格剂量、用法,定期监测血药浓度并实施个体化给药可有效预防永久性内耳功能的损害,常规听力监测能及时发现阿米卡星的耳毒性反应,严格监控下长时程使用阿米卡星是安全的。

Objective To approach the effective measure to prevent and monitor the ototox/city of amika- cin. Methods During the treatment with amikacin for 146 patients with surgery wound infection by non-tuberculous mycobacterium, monitor the hearing capacity and blood drug levels regularly, the date of these measures were summarized. Results The infected wounds of all patients were healing. During the treatment course, no case appearcd hearing loss,56 cases appeared tinnitus and 2 cases appeared dizziness,and these 58 cases were recovery after discontinuation in time. The drug levels in 5 cases showed abortive rise but quickly recovered after adjusting dosage, there was no obvious inner ear leison in these 5 cases. All patients appeared normal liver and renal function throughout treatment. Conclusion Strict dosage and usage, regular monitoring of blood drug levels and individualization dosage can effectively prevent permanent inner ear lesion, routine hearing monitoring can discover ototoxicity of amikacin in time, it is safe that patient receive amikacin for a long course under the strict monitoring.