新生儿万古霉素不同血药浓度对肾功能的影响  

Effects of different trough concentrations of vancomycin on the renal function in neonates

作　　者：陶兴茹 陈海燕[1] 裴保方 段彦彦[1] 马姝丽 Tao Xing-ru;Chen Hai-yan;Pei Bao-fang;Duan Yan-yan;Ma Shu-li(Children's Hospital Affiliated to Zhengzhou University,Children's Hospital of Henan Provincc,Department of Pharmacy,Children's Hospital of Zhengzhou,Zhengzhou 450000)

机构地区：[1]郑州大学附属儿童医院河南省儿童医院郑州儿童医院药学部

出　　处：《中国抗生素杂志》2019年第5期628-631,共4页Chinese Journal of Antibiotics

基　　金：常州四药临床药学科研基金立项科研项目(No.CZSYJJ16014)

摘　　要：目的比较新生儿应用万古霉素后不同血药浓度的肾毒性,分析不同血药浓度下万古霉素的安全性。方法采用回顾性调查方法,收集我院2014年7月1日—2015年6月30日新生儿内科进行万古霉素血药浓度监测的新生儿病例111例。对患儿基本情况、患儿疾病分布、万古霉素血药浓度、病原学检查、药物疗效、合并用药和用药天数、治疗前后肝肾功能等指标进行总结和分析。根据万古霉素血清谷浓度把患儿分为A组(谷浓度<10μg/mL)、B组(谷浓度10~20μg/mL)和C组(谷浓度>20μg/mL)。结果纳入符合标准的患儿111例,万古霉素血清谷浓度<10μg/mL为48例(A组),10~20μg/mL的有40例(B组),>20μg/mL的有23例(B组)。万古霉素治疗期间有13例发生了与万古霉素相关的肾毒性,其中A组2例(4.17%),B组3例(7.5%),C组8例(34.87%)。结论万古霉素谷浓度>20μg/mL时,肾损伤发生率明显升高;新生儿应用万古霉素治疗应进行血药浓度及患儿肾功能的监测,以提高用药的安全性和有效性。Objective To compare the nephrotoxicity of different trough concentrations of vancomycin in the treatment of neonates,and to evaluate the safety of different trough concentrations of vancomycin.Methods The clinical data of neonates who received vancomycin and plasma concentration monitoring from July 2014 to June 2015 were extracted from the neonatal department in our hospital.The general information,disease distribution,plasma concentration monitoring of vancomycin,etiological examination,drug susceptibility test,therapeutic efficacy,combined medication and medication duration,hepatic and renal functions were retrospectively summarized and analyzed.According to the concentrations of vancomycin,the neonates were divided into group A(the trough concentration<10μg/mL),group B(the trough concentration of 10~20μg/mL)and group C(the trough concentration>20μg/mL).Results Of the 111 neonates that conformed to the included standards,48 cases(group A)had serum trough concentrations of vancomycin<10μg/mL,and 40 cases(group B)had serum trough concentrations of vancomycin 10~20μg/mL and 23 cases(group C)had serum trough concentrations>20μg/mL.Vancomycin-related nephrotoxicity occurred in 13 patients during the course of the vancomycin treatment,of which two(4.17%)were in group A,three(7.5%)in group B,and eight(34.87%)in group C.Conclusion The incidence of renal injury increased significantly when vancomycin trough concentrations were larger than 20μg/mL,the plasma concentration and the renal function should be monitored to improve the safety and effectiveness of medication.

关 键 词：万古霉素 新生儿 血药浓度 肾毒性 

分 类 号：R978.1[医药卫生—药品]