万古霉素对幼儿听力的影响研究

Effects of Vancomycin on Hearing in Young Children

目的观察万古霉素的使用对幼儿听力的影响。方法回顾分析于2014年1月至2014年6月北京儿童医院感染科收治的急性感染患儿,治疗方案中使用万古霉素的患儿22名,分别在用药前及用药后进行听力学检测,分析患儿用药前后、伴随用药、不同用药时长的听力阈值、阈值潜伏期情况;比较万古霉素近期药效对听力的影响;分析用药后肝肾功异常情况与听力学的关系。统计学方法为配对t检验或秩和检验,P<0.05为差异有统计学意义。结果共纳入2月-59月患儿22名,中位数年龄为28月,所有患儿用药前后的听性脑干反应阈值、Ⅰ波、Ⅲ波、Ⅴ波潜伏期及Ⅰ-Ⅴ波间期变化均无统计学差异;合并用药组(13例)和非合并用药组(9例),组间听力学变化无统计学差异;依据肝肾功能结果分正常组(14例)和异常组(8例),组间听力学变化无统计学差异;依据用药时长分小于10天组(12例),大于10天组(10例),组间听力学变化无统计学差异。结论 1)万古霉素中短期的使用对幼儿的听力无明显损害;2)合并用药、用药时长。

Object To determine whether vancomycin affects hearing in children. Methods Twenty two children diagnosed with acute infection were treated with vancomycin at Beijing Children＇s Hospital Infectious Disease Department from January 2014 to June 2014. Patients＇ hearing was tested using auditory brainstem responses（ABR） before and after vancomycin treatment. Relations between treatment course, co-administered medications, liver and/or kidney functions and hearing results were analyzed using paired t test or rank-sum test, with P〈0.05 representing statistical significance. Results In the 22 patients（aged from 2months to 59 months with a median age of 28 months）, ABR thresholds at 4 k Hz, latencies of wave I, III and V and the I-V interpeak latency showed no statistically significant differences before and after vancomycin treatment, or when compared between those treated with（n=13） or without（n=9） additional co-administered medications. Nor did hearing show statistically significant differences when compared between patients with（n=8）or without（n=14） co-existing abnormal liver and/or kidney functions. No significant difference in hearing was seen between patients treated for less than 10 days（n=12） and those treated beyond 10 days（n=10）. Conclusion 1） The use of vancomycin has no damaging effects on hearing in young children over short term. 2） However, potentially increased risks for hearing damage associated with co-administration of medications, prolonged duration of treatment or abnormal live/kidney functions may need further studies.