万古霉素对新生儿败血症患儿的临床预后及免疫功能的影响

Influence of vancomycin on clinical outcomes and immune function of neonatal sepsis

目的评价万古霉素对新生儿败血症患儿的临床预后及免疫功能的影响。方法入选53例新生儿败血症患儿为试验组,选取同期在我院产科出生的53例正常新生儿作为对照组。新生儿败血症患儿用头孢硫脒加哌拉西林/舒巴坦进行治疗,明确耐甲氧西林金黄色葡萄球菌败血症患儿改为静脉滴注万古霉素15 mg·kg-1,每天1次,治疗7~10 d,观察新生儿败血症患儿在治疗前后的临床疗效,2组新生儿治疗前后的可溶性白细胞介素-2受体（s IL-2R）、免疫球蛋白G（Ig G）、免疫球蛋白M（Ig M）、膜白细胞介素-2受体（m IL-2R）变化和不良反应。结果治疗后,试验组和对照组的免疫功能指标比较,差异无统计学意义（P〉0.05）。万古霉素治疗后,新生儿败血症患儿有效率为85.72%,显著高于治疗前的28.57%（P〈0.05）。使用万古霉素治疗后患儿出现的皮疹、恶心、呕吐、腹泻及静脉炎等不良反应和未使用万古霉素比较,差异无统计学意义（P〉0.05）。结论万古霉素可有效改善新生儿败血症患儿免疫功能,不良反应轻,有利于患儿的临床预后。

Objective To study the influence of vancomycin on clinical effects and immune function of neonatal sepsis. Methods A total of 53 neonatal sepsis treated in our hospital were selected as the test group, and 53 health normal newborns in the same period in our hospital were selected as the control group. All neonatal sepsis were treated with cefa- thiamidine combined with piperacillin sulbactam, and neonatal sepsis that infected by methieillin -resistant Staphylococcus aureus were treated with vancomycin 15 mg · kg^-1, 1 times a day, and 7 - 10 d was a course. After treatment, clinical efficacy and adverse reactions of chil- dren in test group were observed. Soluble interleukin -2 receptor （slL-2R）, immunoglobulin G （IgG）, immunoglobulin M （IgM）, membranee interleukin - 2 receptor （ mIL - 2R ） of children changes before and after treatment were compared in two groups. Results After treatment, immune function indicators of neonatal sepsis and normal newborns were compared which showed no significant difference （ P 〉 0. 05 ）. After vancomycin treatment, total effective rate of neonatal sepsis was vancomycin 85.72%, which was higher than that before treated with （28.57%, P 〈 0. 05 ） ; and immune function parameters of newborns with Staphylococcus aureus septicemia was improved obviously, which had no significant difference compared with that of normal newborns （ P 〉 0. 05 ）. The incidence of adverse reactions such as rash, nausea, vomiting, diarrhea and phlebitis before and after treatmemt with vancomycin had no significant difference （P 〉 0. 05 ） . Conclusion Vancomycin can effectively improve the immune function in children with neonatal sepsis and reduce ad- verse drug reactions, which can be also conducive to clinical outcomes of children.