临床药师参与重症监护室新生儿万古霉素个体化治疗实践

Pharmaceutical Practice of Clinical Individualized Therapy of Vancomycin in Neonates by Clinical Pharmacists

目的:分析临床药师参与75例重症监护室新生儿万古霉素个体化治疗实践,为新生儿特别是早产儿万古霉素安全合理应用提供参考。方法:收集我院2018年4月至2019年12月临床药师参与万古霉素治疗的75例重症监护新生患儿的临床资料,包括基本信息、疾病分布、病原学检查、万古霉素使用情况、血药浓度、治疗转归及药品不良反应等,进行统计分析。结果:75例重症监护室患儿中,64例(85.33%)为早产儿,疾病分布以败血症最多(55例,73.33%),抗菌药物使用前病原送检率100%,阳性检出率为52.00%(39/75)。首次万古霉素治疗方案医师对药师建议的采纳度为72.00%(54/75),首次谷浓度在5~15μg/mL的患儿占74.67%(56/75),治疗总有效率为70.67%(53/75)。临床药师开展药学监护,有1例患儿用药后出现肝功能损伤,其余患儿无不良反应发生。结论:临床药师参与新生儿万古霉素个体化治疗,监测万古霉素血药浓度,有助于提高新生患儿感染治疗有效率,确保临床用药安全。

Objective:To analyze the pharmaceutical practice of clinical individualized therapy of vancomycin in 75 neonates by clinical pharmacists,so as to provide reference for the safe and rational application of vancomycin in neonates,especially in preterm neonates.Methods:Clinical data of 75 neonates in intensive care unit treated with vancomycin by clinical pharmacists in our hospital from Apr.2018 to Dec.2019 were collected,statistical analysis was performed on basic information,disease distribution,etiological examination,vancomycin use,blood drug concentration,treatment outcome and adverse drug reactions.Results:Of the 75 neonates in intensive care unit,64 cases(85.33%)were preterm neonates,and the disease distribution was most frequent in sepsis(55 cases,73.33%).And 100%of pathogens were sent for testing before the use of antibiotics,the positive detection rate was 52.00%(39/75).The acceptance rate of the first vancomycin treatment was 72.00%(54/75),and 74.67%(56/75)of the children with the first valley concentration from 5 to 15μg/mL,the total effective rate was 70.67%(53/75).Pharmacological monitoring was performed by clinical pharmacists,and one child developed liver injury after administration,while the remaining children had no adverse drug reactions.Conclusion:The participation of clinical pharmacists in the clinical individualized therapy of vancomycin in neonates and blood drug concentration monitoring of vancomycin are helpful to improve the effective rate of infection treatment of neonates and ensure the safety of clinical medication.