新生儿万古霉素血药浓度的影响因素分析

Analysis of Influential Factors for Blood Concentration of Vancomycin in Neonates

目的：分析新生儿万古霉素血药浓度的影响因素,为其临床应用提供参考。方法：采用回顾性调查方法,收集我院2014年7月1日-2015年6月30日新生儿内科进行万古霉素血药浓度监测的新生儿114例,记录其基本信息,采用多因素线性回归分析法考察万古霉素血药浓度的影响因素。结果：114例新生儿万古霉素的血药浓度为2~39μg/ml,平均血药浓度为（13.24±8.66）μg/ml,监测结果在有效血药浓度范围（10~20μg/ml）内的有43例（占37.72%）。新生儿是否早产（r=0.264）和血肌酐水平（r=0.289）与血药浓度呈正相关（P〈0.05）,其出生时体质量（r=-0.264）和血药浓度监测当日体质量（r=-0.236）与血药浓度呈负相关（P〈0.05）;早产儿血肌酐水平（r=0.304）与血药浓度呈正相关（P〈0.05）,其胎龄（r=-0.373）、矫正胎龄（r=-0.431）和血药浓度监测当日体质量（r=-0.263）与血药浓度呈负相关（P〈0.05）。结论：新生儿是否早产、体质量、胎龄和血肌酐水平等因素均有可能影响其体内万古霉素的血药浓度。临床应用万古霉素时应综合考虑各影响因素,并结合患儿血药浓度监测结果和临床症状进行治疗方案的调整。

OBJECTIVE： To analyze the influential factors for blood concentration of vancomycin in neonates, and to provide reference for clinical medication. METHODS： In retrospective study, 114 cases of blood concentration monitoring of vancomycin were collected from neonatal department of our hospital during Jul. 1st 2014 to Jun. 30th 2015, and general information were recorded; the influential factors for blood concentration of vancomycin were analyzed by multiple factors linear regression analysis. RESULTS： The blood concentrations of vancomycin in 114 neonates were 2-39 μg/ml, and average blood concentration was （13.24 ＋ 8.66） μg/ml. The blood concentrations of 43 cases were within effective range （10-20 μg/ml）, accounting for 37.72%. Premature （r=0.264） and serum creatinine level （r=0.289） of neonates were positively correlated with blood concentration （P〈0.05） , while birth weight （r= -0.264） and body weight on monitoring day （r=-0.236） were negatively correlated with blood concentration （P〈0.05）. The serum creatinine level （r=0.304） of prematures was positively correlated with blood concentration （P〈 0.05）, and gestational age （r=-0.373）, correct gestational age （r=-0.431） and body weight on monitoring day （r=-0.263） were negatively correlated with blood concentration （P〈0.05）. CONCLUSIONS： Premature, body weight, gestational age, serum creatinine level and other factors all influence the blood concentration of vancomycin. The influential factors should be considered when using vancomycin. Treatment plan should be adjusted according to the results of blood concentration and clinical symptom.