39例新生儿万古霉素血药浓度监测与用药分析

Blood concentration monitoring and medication analysis of vancomycin in neonates:39 cases

目的：评价万古霉素在新生儿的临床应用及其血药浓度监测情况,为临床合理用药提供参考。方法：采用回顾性分析方法,收集2012-2013年在新生儿使用万古霉素治疗并进行血药浓度监测的39例,对其疾病分布、病原学检查、PCT检测、药物敏感试验、用药天数、药物疗效、合并用药、肝肾功能等指标进行统计分析。结果：39例患儿中临床第一诊断为新生儿肺炎者比例最高,为29例（74.36%）;病原学送检率100%,阳性检出率69.2%;药物敏感试验显示对万古霉素高度敏感的占77.78%;PCT送检率97.44%;万古霉素血药谷浓度范围在15-20μg·ml^-1的为19.05%;平均用药时间（12.4±4.9）d;联合应用2种抗菌药物的比例为84.62%;抽样患儿使用万古霉素治疗的有效率为89.7%。结论：新生儿使用万古霉素治疗由革兰阳性菌引起的重症感染疗效确切,但应进行血药浓度（谷浓度）监测,使其血药浓度维持在安全有效范围内,以提高用药的安全性和有效性。

OBJECTIVE To evaluate the clinical application and blood concentration monitoring of vancomycin in neonates,and provide a reference for clinical rational drug use.METHODS Retrospective analysis method was adopted to perform statistical analysis of disease distribution,etiological examination,PCT test,drug sensitive test,medication duration,therapeutic efficacy,drug combination,hepatic and renal function,etc.in39 neonate patients who received vancomycin and blood concentration monitoring.RESULTS Of 39 patients,29 patients（74.36%）were diagnosed neonatal pneumonia.All patients received etiological examination,and 69.2% showed positive.Drug sensitivity test showed 77.78% patients were sensitive to vancomycin;97.44% received PCT;19.05% patients had a trough concentration range of vancomycin between 15 and 20μg·ml-1;the mean duration of medication was（12.4±4.9）d;84.62% patients received combination of 2 drugs;the effective rate of vancomycin for sampled neonates was 89.7%.CONCLUSION Vancomycin has definite therapeutic effects in neonates with severe infection caused by Gram-positive bacteria.However,the drug concentration（trough concentration）should be monitored to ensure the blood concentration be maintained within the safe and effective range,to improve drug safety and efficacy.