儿童患者中开展万古霉素血药浓度监测的研究

Investigation of therapeutic drug monitoring of vancomycin in pediatric patients

目的探讨我院儿科万古霉素使用现状以及药师干预在个体化治疗中的作用。方法临床药师参与临床建立万古霉素的个体化治疗模式。对药师干预前后我院儿科万古霉素的临床使用情况进行比较分析。结果药师参与后,进行治疗药物监测(TDM)的患儿比例由17.02%上升至53.33%(P<0.05),新生儿比例由37.50%上升至80.00%(P<0.05),进行TDM的平均时间由首次给药后(7.52±4.93)d调整为(3.98±2.23)d(P<0.05),万古霉素谷浓度监测率达100%,平均谷浓度为(7.97±6.68)mg·L-1,临床有效率从78.72%提升至81.90%(P>0.05),经验治疗比例由65.96%下降至48.57%(P<0.05)。依据监测结果进行给药方案调整的比例由18.75%提高至26.67%(P>0.05),不良反应发生率由5.42%下降至4.67%(P>0.05)。结论我院儿科万古霉素的临床使用基本合理,但目前针对儿科患者的TDM谷浓度推荐范围还有待商榷。药师能够在患者的个体化治疗中发挥重要作用。

Objective To investigate the used situation of vancomycin in our hospital＇s pediatrics and the role of the pharmacists＇ intervention in individualized treatment of vancomycin.Methods The clinical pharmacist established an individualized treatment model of vancomucin.The usage of vancomycin before and after pharmacist ＇s intervention in our hospital＇s pediatric patients was compared and analyzed.Results After the pharmacists＇ intervention,the therapeutic drug monitoring（ TDM）proportion of children raised from 17.02% to 53.33%（ P〈0.05）,the proportion of newborns raised from 37.50% to 80.00%（ P〈0.05）.The average TDM time adjusted from（ 7.52 ± 4.93） d to（ 3.98 ± 2.23）d（ P〈0.05）.The vancomycin trough concentration monitoring rate was100%.The average trough concentration was（ 7.97 ＋ 668） mg · L^-1.The clinical efficiency increased from 78.72% to 81.90%（ P〉0.05）.The proportion of experience treatment decreased from 65.96% to48.57%（ P〈0.05）.According to TDM results,the proportion of dosage adjustment increased from 18.75% to 26.67%（ P〉0.05）.The adverse reactions rate reduced from 5.42% to 4.67 %（ P〈0.05）.Conclusion The use of vancomycin in our hospital＇s inpaitent pediatrics is reasonable.The recommended TDM trough concentration range for pediatric patients is debatable.Pharmacists can play an important role in the individualized treatment of patients.