万古霉素治疗儿童革兰阳性球菌重症肺炎血药浓度与疗效分析

Serum vancomycin concentration distribution and its clinical therapeutic effect on children with severe Gram-positive cocci pneumonia

目的 分析万古霉素血药浓度分布特点及其与革兰阳性球菌重症肺炎疗效的关系。方法 回顾性分析2012年10月-2014年10月使用万古霉素治疗的59例革兰阳性球菌重症肺炎患儿万古霉素血药浓度值,分析其与临床生化指标、疾病状态的相关性;并分析临床因素对万古霉素疗效的影响。结果 40~60 mg/（kg·d）给药方案的治疗有效率高于〈40 mg/（kg·d）,差异有统计学意义（89.47%对46.15%,P=0.004）,而〉60 mg/（kg·d）治疗有效率未进一步提高。合并非青紫型先天性心脏病患儿的血药谷浓度高于无先天性心脏病患儿,差异有统计学意义（12.12 mg/L对7.76 mg/L,P=0.008）。用药前急性肝功能受损、中重度贫血可能是万古霉素治疗革兰阳性球菌重症肺炎疗效不佳的危险因素,差异有统计学意义（P〈0.05）。结论 万古霉素治疗革兰阳性球菌重症肺炎推荐选择40~60 mg/（kg·d）给药方案;合并非青紫型先天性心脏病,用药前急性肝功能受损、中重度贫血可能影响药物浓度和治疗效果。

Objective To analyze the characteristics of serum vancomycin concentrations and its clinical therapeutic effects. Methods Serum vancomycin concentrations of 59 children diagnosed with severe Gram positive cocci pneumonia and treated with vancomycin were retrospectively analyzed. Vancomycin concentrations, biochemical values and disease status of patients were analyzed. Results The serum vancomycin concentrations of severe Gram positive cocci pneumonia children accompanied by acyanotic congenital heart disease was significantly higher than those without congenital heart disease, （ 12 . 12 mg/L vs 7 . 76 mg/L, P= 0 . 008 ）. The therapeutic effect of 40 - 60 mg/（kg·d） dosage group was significantly higher than that of 〈 40 mg/（kg·d） group （ 89 . 47 % vs 46 . 15 %, P= 0 . 004 ）, while the therapeutic effect was similar between 40 - 60 mg/（kg·d） and 〉 60 mg/（kg·d） dosage group. Acute liver function damage and moderate/severe anemia may be risk factors for poor therapeutic effects to severe Gram positive cocci pneumonia children （P 〈 0 . 05 ）. Conclusions Severe Gram positive cocci pneumonia children accompanied by acyanotic congenital heart disease may lead to a high serum vancomycin concentration. The 40 - 60 mg/（kg·d） dosage group may reach a satisfactory therapeutic effect. For children with acute liver function damage and moderate/severe anemia, a close monitoring to the state of illness is recommended to prevent poor prognosis.