万古霉素不良反应报告分析

Adverse reaction reports of vancomycin in a hospital

目的通过分析万古霉素药品不良反应发生情况,为临床提供安全警示参考,降低风险实现合理用药。方法收集首都医科大学附属北京积水潭医院2017年1月1日至2023年12月31日上报的药品不良反应报告,分析并检索同类文献内容。结果我院7年间收集上报的药品不良反应共1023例,其中应用万古霉素导致71例,仅1例评价为“严重”,其余均为“一般”;其中男性占比高于女性,年龄多集中在18~65岁;81.69%病例日剂量为2 g;原患疾病主要集中在各种骨折术后、人工关节置换术后、骨髓炎、多发损伤、皮肤损伤、烧伤等病因导致的感染;发生ADR的患者中45.07%在输液当天出现不同反应,其中34.38%的病例在1 h内出现瘙痒、皮疹、潮红、红人综合征、头痛、胃部不适,7 d以后出现的不良反应普遍集中在血细胞减少。结论万古霉素是我院发生不良反应最多的药品,临床应重点关注易发性别和年龄的患者,规范日剂量,积极监测血药浓度,充分告知患者可能的不良反应表现并制定针对性的用药方案,在输注过程中密切监护患者状态,并做好患者血常规监测工作。

Objective To analyze the incidence of adverse drug reactions of vancomycin so as to provide reference for clinical safety warning,reduce the risk and ensure rational drug use.Methods Reports of adverse drug reactions by our hospital between 2017 and 2023 were collected and analyzed using Excel 2016.Results A total of 1023 cases of adverse drug reactions were collected and reported in our hospital in the past 7 years Among these cases,71 were caused by vancomycin,only one was determined as“serious”,and the rest were“mild”.Male patients outnumbered female ones,and the age of these patients mostly ranged from 18 to 65.In 81.69%of the cases,the daily dose was 2 g.The primary diseases included infections caused by fractures,artificial joint replacement,osteomyelitis,multiple injuries,skin injuries and burns.Nearly 45.07%of the patients with adverse drug reactions showed different reactions on the day of infusion,and 34.38%developed pruritus,rash,flushing,red man syndrome,headache,and stomach discomfort within 1h.The dominating adverse reaction after 7 days was hemopenia.Conclusion Vancomycin is the drug that has induced the largest number of adverse reactions in our hospital.The vulnerable gender and age group deserve more attention.The daily dose should be standardized and blood concentration should be monitored.Pharmacists should inform patients of possible adverse reactions and formulate targeted medication plans while nurses should closely monitor patients’conditions during infusion.