我院重症感染新生儿应用万古霉素血药浓度监测结果分析

Result Analysis of Plasma Concentration Monitoring of Vancomycin in Neonate with Severe Infection in Our Hospital

目的：为促进重症感染新生儿合理应用万古霉素提供参考。方法：回顾性分析我院2012年6月-2014年6月间重症感染新生儿的万古霉素血药浓度监测结果及其相关信息。结果：30例重症感染新生儿应用万古霉素治疗总有效率为63.33%。其中,7例稳态谷浓度小于10 mg/L（占23.33%）,有效率为16.67%;22例在10~20 mg/L（占73.33%）,有效率为77.27%;1例大于20 mg/L（占3.33%）,有效率为100%。有2例采用qd给药,疗程最短的仅2 d。病原学检查送检率为96.67%,其中阳性率为89.65%。治疗期间未发现患儿有明显不良反应及肝、肾功能损害情况。结论：我院重症感染新生儿应用万古霉素治疗总有效率偏低,可能与万古霉素的稳态谷浓度偏低有关。部分临床应用尚不够规范,存在疗程不足、给药间隔不当等不合理用药情况。严格按标准使用及加强血药浓度监测对指导万古霉素临床合理应用具有重要意义。

OBJECTIVE：To provide reference for promoting the rational use of vancomycin in neonate with severe infection.METHODS：The results of plasma concentration monitoring of neonate with severe infection in our hospital from Jun.2012 to Jun.2014 and related information were retrospectively analyzed.RESULTS：The total effective rate of vancomycin in 30 neonates with severe infection was 63.33%.Among these,7 cases（23.33%）were less than 10 mg/L with an effective rate of 16.67%;22 cases（73.33%）were in the range of 10-20 mg/L with an effective rate of 77.27%;1 case（3.33%）was more than 20 mg/L with an effective rate of 100%.2 cases were administrated,qd,and the shortest course was only 2 d.96.67% received etiological examination and 89.65% showed positive.There were no obvious adverse reactions and the damage of liver and kidney function.CONCLUSIONS：The low effective rate of vancomycin in neonate with severe infection in our hospital may be related to the low steady-state plasma concentration.Part of the clinical application is still non-standard,such as not enough course and improper dosing interval,etc.Strengthening the supervision of application standard and the monitoring of plasma concentration has important significance for rational use of drug.