等剂量万古霉素治疗重症肺炎合并先天性心脏病患儿的血药浓度分布特点及疗效

Equidose Characteristics and Efficacy of Blood Concentration of Vancomycin on Children with Severe Pneumonia and Congenital Heart Disease

目的探讨等剂量万古霉素治疗重症肺炎合并先天性心脏病患儿的血药浓度分布特点及疗效。方法纳入2018年4月至2019年4月在我院确诊为重症肺炎的50例患儿作为对照组,选取同一时间段在我院确诊并接受治疗的重症肺炎合并先天性心脏病的50例患儿作为观察组,两组患儿监护人均知情。对所有患儿均予以等剂量注射用盐酸万古霉素治疗,10 mg/(kg·次),每日4次,在给药1周后采集患儿的静脉血进行检测,统计万古霉素的血药浓度分布特点,同时根据患儿的临床症状及指标变化评价患儿的治疗效果,并分析二者之间的关系。结果观察组治疗总有效率高于对照组(P<0.05);观察组万古霉素血药浓度最高平均值为(28.40±6.67)mg/L,最低平均值为(13.35±6.61)mg/L,对照组万古霉素血药浓度最高平均值为(16.24±5.49)mg/L,最低平均值为(2.78±1.00)mg/L,组间差异有统计学意义(P<0.05)。100例患儿中,治疗有效患儿万古霉素血药浓度最高平均值为(23.57±7.39)mg/L,最低平均值为(9.29±7.34)mg/L,治疗无效患儿万古霉素血药浓度最高平均值为(18.69±8.49)mg/L,最低平均值为(4.58±5.12)mg/L,组间差异有统计学意义(P<0.05)。最高浓度、最低浓度与治疗效果的ROC曲线分析显示,曲线下面积分别为0.75(95%CI:0.548~0.936,P=0.010)、0.77(95%CI:0.604~0.934,P=0.004),可见药物使用浓度与治疗效果呈正相关;最佳疗效的临界值:最高浓度为15.70μg/mL,约登指数为0.50,最低浓度为5.21,约登指数为0.33。结论对于重症肺炎合并先天性心脏病患儿来说,万古霉素的应用效果较好,有助于提升患儿的血药浓度,因此在临床用药过程中应进行血药浓度监测,确保安全用药。此外,万古霉素的血药浓度与治疗效果呈正相关,但临床应注意将剂量控制在临界值范围内。

Objective To study the efficacy,concentration distribution and relationship between severe pneumonia and congenital heart disease treated with equal dose vancomycin.Methods Fifty children with severe pneumonia were included as the control group.The children with severe pneumonia complicated with congenital heart disease who will be diagnosed and treated in our hospital at the same time will be used as the observation group of this study.The distribution characteristics of vancomycin blood concentration in children were counted,and the therapeutic effect was evaluated according to the changes of clinical symptoms and indexes,and the relationship between them was analyzed.Results The total effective rate of treatment in the observation group was higher than that in the control group(P<0.05);the highest average blood concentration of vancomycin in the observation group was(28.40±6.67)mg/L,and the lowest average was(13.35±6.61)mg/L.The highest average value of vancomycin blood concentration in the control group was(16.24±5.49)mg/L,and the lowest average value was(2.78±1.00)mg/L.The difference between the groups was statistically significant(P<0.05).Among the 100 children,the highest average blood concentration of vancomycin in children with effective treatment was(23.57±7.39)mg/L,and the lowest average value was(9.29±7.34)mg/L.The highest average drug concentration was(18.69±8.49)mg/L,and the lowest average value was(4.58±5.12)mg/L.The difference between the groups was statistically significant(P<0.05).The ROC curve analysis of the highest concentration,the lowest concentration and the treatment effect showed that the area under the curve was 0.75(95%CI:0.548~0.936,P=0.010)and 0.77(95%CI:0.604~0.934,P=0.004),respectively.The concentration of the drug used is positively correlated with the therapeutic effect;the cut-off value for the best curative effect:the highest concentration is 15.70μg/mL,the Youden index was 0.50,the lowest concentration is 5.21,and the Youden index was 0.33.(P<0.05).Conclusion For children with severe pneumonia combined with congenital heart disease,vancomycin has a better application effect and helps to increase the blood concentration of the children.Therefore,blood concentration monitoring should be carried out during clinical medication to ensure safe medication.In addition,the blood concentration of vancomycin is positively correlated with the therapeutic effect,but clinical care should be taken to control the dose within the critical value range.