102例新生儿万古霉素血药浓度监测与临床应用评价  

Therapeutic Drug Monitoring and Clinical Evaluation of Vancomycin in 102 Neonates

作　　者：唐喆[1] 王菲[1] 管静[1] 陈小慧[2] TANG Zhe;WANG Fei;GUAN Jing;CHEN Xiaohui(Department of Pharmacy Obstetrics and Gynecology Hospital Affiliated to Nanjing Medical University,Nanjing 210004,China;Department of Neonatology,Obstetrics and Gynecology Hospital Affiliated to Nanjing Medical University,Nanjing 210004,China)

机构地区：[1]南京医科大学附属妇产医院药学部,南京210004 [2]南京医科大学附属妇产医院新生儿科,南京210004

出　　处：《医药导报》2018年第9期1056-1061,共6页Herald of Medicine

基　　金：南京药学会-常州四药医院药学科研基金资助项目(2015YX013)

摘　　要：目的评价万古霉素治疗新生儿严重细菌感染时的疗效及其血药浓度监测情况,为临床合理用药提供参考。方法采用回顾性调查方法,收集应用万古霉素进行抗感染治疗的新生儿102例,对其疾病分布、血药浓度监测、生化检查、病原学检查、药物敏感试验等结果进行统计分析,并利用Mehrotra建立的新生儿万古霉素PK模型对24 h药物浓度-时间曲线下面积与最小抑菌浓度比值(AUC24/MIC)靶值进行预测。结果 102例患儿中临床第一诊断为新生儿败血症者比例最高;初次血药浓度监测范围在10～20μg·m L-1的患儿占36.27%;经使用万古霉素治疗后,C反应蛋白(CRP)、血肌酐(Cr)、尿素(Urea)、总胆红素(T-Bi L)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)均显著下降;分离培养出革兰阳性菌73例,得到AUC24/MIC靶值73个,大多数靶值远小于《万古霉素临床应用中国专家共识(2011年版)》推荐值(400)。结论万古霉素治疗由革兰阳性菌引起的新生儿重症感染疗效确切,但须进行血药浓度监测,以提高安全性和有效性。Objective To evaluate the efficacy of vancomycin used to treat severe bacterial infections of neonates and to provide a reference for clinical drug application.Methods In total,102 neonates treated with vancomycin were retrospectively analyzed.Disease distribution,results of therapeutic drug monitoring,bio-chemical examination,etiological examination and drug sensitive test were statistically analyzed.PK model established by Mehrotra was applied to calculate the ratio of drug concentration-area under the curve in 24 h and minimal inhibitory concentration(AUC 24/MIC).Results Among the 102 cases,patients diagnosed with neonatal sepsis accounted for the highest percentage.And 36.27%of the patients had a trough concentration of vancomycin within the range of 10–20μg·mL-1 in the first serum concentration test.After a treatment of vancomycin,clinical biomarker values of CRP,Cr,Urea,T-BiL,ALT and AST were decreased significantly.Totally,73 cases of Gram-positive bacteria were isolated and cultured and AUC 24/MIC values were calculated.Most of them were much less than 400(which is recommended by the expert consensus document).Conclusion Vancomycin has a definite efficacy in treating severe infections caused by Gram-positive bacteria in neonates.However,therapeutic drug monitoring should be applied in order to enhance security and effectiveness.

关 键 词：万古霉素 新生儿 治疗药物监测 

分 类 号：R978.1[医药卫生—药品] R969.3[医药卫生—药学]