儿童万古霉素血药浓度监测及初始剂量优化  

Serum Concentration Monitoring and Initial Dose Optimization of Vancomycin in Children

作　　者：刘香芳[1] 滕文兵 倪穗琴[1] LIU Xiangfang;TENG Wenbing;NI Suiqin(Department of Clinical Pharmacy,Guangzhou First People's Hospital,Guangzhou,Guangdong 510013,China)

机构地区：[1]广州市第一人民医院临床药学科,广东广州510013

出　　处：《今日药学》2022年第2期146-149,共4页Pharmacy Today

基　　金：广东省医学科学技术研究基金(A2019572)。

摘　　要：目的通过分析某院0~6岁患者万古霉素血药浓度达标率及用药剂量的关系,探讨优化儿童患者万古霉素给药方案。方法根据纠正胎龄后的年龄将患儿分为A(年龄<7 d),B(年龄7~28 d),C(年龄>28 d)3组,分析不同年龄组患儿万古霉素血药浓度水平和达标率情况,比较说明书推荐剂量、指南推荐剂量与实际剂量的差别。结果106例0~6岁患儿监测万古霉素血药浓度168例次,以5~15 mg·L^(-1)为目标谷浓度的万古霉素达标率为57.74%(98/168)。A、B、C 3组的血药浓度达标率分别为43.59%(17/39),54.00%(27/50)和67.09%(53/79),A、B组达标率低于C组,差异有统计学意义(P<0.05)。A、B、C 3组的平均血药浓度分别为(15.88±1.36),(13.51±0.82)和(11.10±0.69),C组的平均血药浓度低于另外2组,差异有统计学意义(P<0.05)。A组浓度达标患者的实际用量高于指南推荐剂量,差异有统计学意义(P<0.05),与说明书推荐的最大剂量差异无统计学意义(P>0.05)。B组浓度达标患者的实际用量高于说明书及指南推荐剂量,差异均有统计学意义(P<0.05)。C组浓度达标患者的实际用量高于说明书推荐剂量,差异有统计学意义(P<0.05),与指南推荐剂量差异无统计学意义(P>0.05)。结论该院0~6岁患儿万古霉素血药浓度达标率整体偏低,尤其是新生儿。对于肾功能正常的儿童,日龄7 d以内的患儿初始剂量可以按照说明书用药,日龄大于7 d的患儿可用稍大于说明书推荐的最大剂量,说明书推荐1月以上患儿的用药剂量偏小,应按照指南每天至少给予60 mg·kg^(-1)的初始剂量。OBJECTIVE To discusse how to optimize the dosage of vancomycin in child patients by analyzing the relationship between the serum concentration and the dosage of vancomycin in 0-6 years old patients in a hospital.METHODS According to the corrected gestational age,the children were divided into three groups:A(age <7 d),B(age 7-28 d),and C(age>28 d),and the serum concentration of vancomycin in different age groups were analyzed.Compared the difference between instruction dosage,guideline dosage and actual dosage.RESULTS 168 samples of vancomycin serum concentration in 106 children aged 0-6 years were enrolled,it was found that only 57.74%(98/168) samples reached the target trough concentration(5-15 mg·L^(-1)).The target concentration rates of group A,B and C were 43.59%(17/39),54.00%(27/50),and 67.09%(53/79).Group A and B were significantly lower than that of group C,the difference was statistically significant(P<0.05).The average serum concentration of group A,B and C were(15.88±1.36),(13.51±0.82) and(11.10±0.69),respeccively.The average serum concentration of group C was significantly lower than that of the other two groups,and the difference was statistically significant(all P<0.05).The actual dosage of patients in group A that reached the target concentration was significantly higher than the guideline dosage,the difference was statistically significant(P<0.05),but there was no statistically significant difference from the maximum dose recommended in the instructions(P>0.05).The actual dosage of patients in group B that reached the target was significantly higher than the instruction dosage and guidelines,and the differences were statistically significant(P<0.05).The actual dosage of the patients in group C that reached the target was significantly higher than instruction dosage,the difference was statistically significant(P<0.05),and there was no significant difference from the guideline dosage(P>0.05).CONCLUSION The serum concentration of vancomycin in children aged 0-6 in the hospital is overall low,espec

关 键 词：儿童 万古霉素 血药浓度 用药剂量 

分 类 号：R985[医药卫生—药品]