早产儿万古霉素治疗34例药物监测与用药分析

Therapeutic drug monitoring and medication analysis of 34 cases of vancomycin in premature infants

目的评估万古霉素早产儿治疗药物监测(Therapeutic Drug Monitoring,TDM)及用药情况,分析万古霉素在早产儿重症感染治疗过程中进行TDM的必要性。方法采用回顾性分析方法,制定相应标准,按标准收集2016—2018年南京医科大学附属无锡妇幼保健院早产儿34例,统计分析其基本情况、血培养、痰培养等相关病原学检查、药敏试验结果、血药浓度结果、化验室指标、药物疗效及药品不良反应(Adverse Drug Reaction,ADR)等结果。结果统计分析的34例病儿中,诊断以新生儿脓毒血症为主(48.94%),病原学送检率100%,阳性检出率76.47%,22例(占83.33%)为革兰阳性菌感染,药敏试验结果均显示对万古霉素敏感;监测范围在10~20μg/mL的初次血药谷浓度病儿极少(仅占26.47%),而通过临床药师合理干预可大大提高谷浓度的达标率(占76.92%),差异有统计学意义(P<0.05)。经万古霉素治疗后有效率达85.29%,复查病儿的各项指标较前有明显好转[降钙素原(PCT)为(0.86±0.28)比(0.31±0.43)ng/mL,尿素(Urea)为(5.39±3.91)比(2.24±1.35)mmol/L,血肌酐(Cr)为(64.24±20.44)比(34.43±9.82)μmol/L,胱抑素C(CysC)为(1.85±0.55)比(1.29±0.28)mg/L、天冬氨酸氨基转移酶(AST)为(43.72±25.03)比(25.03±11.01)IU/L,均P<0.05];未检测到万古霉素引起的耳肾损害等ADR。结论万古霉素治疗早产儿感染,特别是革兰阳性菌引起的重症感染效果明确。进行TDM可以实现早产儿万古霉素治疗个体化,使早产儿用药更加安全有效。

Objective To evaluate the therapeutic drug monitoring(TDM)and the medicatiom application of vancomycin in premature infants,and analyze the necessity of using vancomycin in the treatment of severe infection in premature infants.MethodsRetrospective analysis method was used to establish the corresponding standards.According to the standard,34 cases of premature infants in Wuxi Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University from 2016 to 2018 were collected.The basic information,blood culture,sputum culture and other related etiological examination,drug sensitivity test results,blood drug concentration results,laboratory indicators,drug efficacy and adverse drug reaction(ADR)results were statistically analyzed.ResultsAmong the 34 cases,most of them were diagnosed as neonatal sepsis(48.94%).All cases received etiological examination,and 76.47%showed positive.Among them,22 cases(83.33%)were Gram-positive bacteria infection.The results of drug sensitivity test were all sensitive to vancomycin.Only 26.47%cases were monitored within the range of 10-20μg/mLin initial blood drug valley concentrations,and the compliance rate of valley concentrations could be greatly improved by reasonable intervention of clinical pharmacists(76.92%,P<0.05).After vancomycin treatment,the effective rate reached 85.29%.During the re-examination,the indicators were significantly better than before[PCT(0.86±0.28)vs.(0.31±0.43)ng/mL,Urea(5.39±3.91)vs.(2.24±1.35)mmol/L,Cr(64.24±20.44)vs.(34.43±9.82)μmol/L,CysC(1.85±0.55)vs.(1.29±0.28)mg/L、AST(43.72±25.03)vs.(25.03±11.01)IU/L,all P<0.05],and no ADRs such as ear and kidney damage occurred.Conclusion Vancomycin has definite therapeutic effects in the treatment of premature infants with infections,especially severe infections caused by Gram-positive bacteria.TDM can realize the individualization of vancomycin treatment in preterm infants,and make the medication of preterm infants safer and more effective.