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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 被引量:8

Serum concentration monitoring and pharmacokinetic characters of vancomycin in child patients from pediatric intensive care unit
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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 (P〈0.05和P〈0.01)。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,P〈0.05]。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。 AIM To understand the serum concentrations and pharmacokinetic parameter distribution of vancomycin in child patients from pediatric intensive care unit (PICU), and preliminary determine if the normal dosage could reach the target trough concentration or not. METHODS Totally 60 child patients (41 boys and 19 girls) received vancomycin (39.99 ±4.42) mg·kg-1 .d-1 were involved in the research. Enzyme-mutiplied immunoassay technique was used to measure vancomycin serum concentrations, and 1- compartment model and Sawchuk-Zaske method were used to calculate the patients' pharmacokinetic parameters, then the parameters were compared with those from package insert and former vancomycin pharmacokinetics research in children, meanwhile, the data between younger than 2 years and older than 2 years were compared. RESULTS Among the 60 child patients, 30 child patients' trough concentrations were 5 to 15 mg.L-1, only 4 reached 15 to 20 mg· L-1, 2 above 20 mg·L-1; 6 child patients' peak concentrations were above 40 mg·L-1. AUC24 h of 32 patients were above 400 mg·h·L-1. Vd in the study was higher than that of package insert and literatures (P 〈 0.05, P 〈 0.01 ) . The patients older than 2 years had higher elimination rate constant than younger than 2 years [(0.22 ±0.10) h-1 vs. (0.27 ± 0.09) h-1, P 〈 0.05] . CONCLUSION The dosage of vancomycin recommended by the package insert (40 mg ·kg-1·d-1) is not enough to reach the target trough concentration in all patients from PICU, and sometimes they need higher loading dosage.
出处 《中国新药与临床杂志》 CAS CSCD 北大核心 2015年第2期133-136,共4页 Chinese Journal of New Drugs and Clinical Remedies
关键词 万古霉素 重症监护病房 儿科 药物监测 药动学 vancomycin intensive care units, pediatric drug monitoring pharmacokinetics
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