重症感染患儿万古霉素血清谷浓度与肾损伤及临床疗效的关系  

Relationship between serum trough concentration of Vancomycin and renal injury and clinical efficacy in children with severe infection

作　　者：朱德胜[1] 曾方玲[2] 姚震亚[1] 周武 ZHU Desheng;ZENG Fangling;YAO Zhenya;ZHOU Wu(The Second Department of Critical Care Medicine,Hu′nan Children′s Hospital,Hu′nan Province,Changsha410007,China;the Second Department of Emergency Comprehensive,Hu′nan Children′s Hospital,Hu′nan Province,Changsha410007,China)

机构地区：[1]湖南省儿童医院重症医学二科,湖南长沙410007 [2]湖南省儿童医院急诊综合二科,湖南长沙410007

出　　处：《中国医药导报》2019年第24期119-122,149,共5页China Medical Herald

基　　金：湖南省卫生计生委科研计划课题(B20180512)

摘　　要：目的探讨重症感染患儿万古霉素血清谷浓度与肾损伤及临床疗效的关系。方法选取2017年5月~2018年5月湖南省儿童医院收治的重症感染患儿158例,根据万古霉素血清谷浓度将患儿分为A组(n=52,<5 mg/L)、B组(n=53,5~10 mg/L)和C组(n=53,>10 mg/L)。比较三组治疗后的临床疗效、细菌学疗效、肾功能相关指标;记录三组患儿治疗期间不良反应发生情况。结果三组患儿临床总有效率比较,差异有统计学意义(P<0.05),其中B组、C组患儿临床总有效率显著高于A组,且B组高于C组,差异均有统计学意义(P<0.05)。三组患儿细菌学总有效率比较,差异有统计学意义(P<0.05),其中B组、C组患儿细菌学总有效率显著高于A组,且B组高于C组,差异均有统计学意义(P<0.05)。三组患儿治疗后尿素氮(BUN)、血清肌酐(Scr)、胱抑素-C(Cys-C)均较治疗前升高,且C组BUN、Scr、Cys-C高于A组、B组,差异均有统计学意义(P<0.05),但A、B两组治疗后BUN、Scr、Cys-C比较,差异无统计学意义(P>0.05)。三组患儿病死率比较,差异无统计学意义(P>0.05)。结论万古霉素不同血清谷浓度具有不同的临床总有效率以及细菌学总有效率,其中5~10 mg/L万古霉素血清谷浓度的疗效较佳,对患儿肾损伤影响较轻,且不会增加患儿病死率,具有一定的临床应用价值。Objective To investigate the relationship between serum trough concentration of Vancomycin and renal injury and clinical efficacy in children with severe infection.Methods A total of 158 children with severe infection admitted to the Hu′nan Children′s Hospital from May 2017 to May 2018 were enrolled.They were divided into group A(n=52,<5 mg/L),group B(n=53,5-10 mg/L)and group C(n=53,>10 mg/L)according to the serum concentration of Vancomycin.The clinical efficacy,bacteriological efficacy,and renal function related indexes of the three groups were compared.The incidence of adverse reactions during the treatment of the three groups was recorded.Results There was significant difference in the total clinical effective rate among the three groups(P<0.05).The total clinical effective rate of group B and group C was significantly higher than that of group A,and group B was higher than that of group C,the differences were statistically significant(P<0.05).The total effective rate of bacteriology in group B and group C was significantly higher than that in group A,and group B was higher than that in group C,the differences were statistically significant(P<0.05).Urea nitrogen(BUN),serum creatinine(Scr)and cystatin-C(Cys-C)increased after treatment in three groups,and BUN,Scr and Cys-C in group C were higher than those in group A and group B,the differences were statistically significant(P<0.05),but there was no significant difference in BUN,Scr and Cys-C between two groups after treatment(P>0.05).There was no significant difference in mortality among the three groups(P>0.05).Conclusion The different serum concentrations of Vancomycin have different clinical total effective rate and total bacteriological efficiency.Among them,the serum concentration of 5-10 mg/L Vancomycin is better,and the effect on kidney injury is lighter.It will not increase the mortality rate of children and has certain clinical application value.

关 键 词：重症感染 患儿 万古霉素 血清谷浓度 肾损伤 临床疗效 

分 类 号：R96[医药卫生—药理学]