104例新生儿使用硫酸丁胺卡那霉素临床分析  

Clinical analysis of amikacin sulfate used in 104 neonates

作　　者：胡又宁 范颖[1] 王政力[1] 邓春[1] Hu Youning;Fan Ying;Wang Zhengli;Deng Chun(Department of Neonatology,Children's Hospital of Chongqing Medical University,National Clinical Research Center For Child Health and Disorders,Ministry of Education Key Laboratory of Child Development and Disorders,Chongqing Key Laboratory of Pediatrics)

机构地区：[1]重庆医科大学附属儿童医院新生儿科、国家儿童健康与疾病临床医学研究中心、儿童发育疾病研究教育部重点实验室、儿科学重庆市重点实验室,重庆400014

出　　处：《重庆医科大学学报》2022年第5期607-613,共7页Journal of Chongqing Medical University

摘　　要：目的:对重庆医科大学附属儿童医院新生儿病区静脉使用硫酸丁胺卡那霉素(阿米卡星)的患儿进行病例分析,总结使用阿米卡星的病原学依据、剂量、疗效、耳毒性、肾毒性,为临床用药提出指导。方法:回顾性分析重庆医科大学附属儿童医院新生儿病区2013年1月至2018年12月住院治疗的104例静脉使用阿米卡星的患儿病历资料,包括患儿的一般信息、病原学检查结果、主要诊断、阿米卡星使用情况、肾功能,并电话随访患儿出院后的听力情况。结果:本研究纳入静脉使用阿米卡星新生儿病例104例,平均胎龄为(32±4)周,出生体质量为1395.00(1131.25,2190.00)g,血流感染、呼吸道感染、肠道感染、颅内感染是使用阿米卡星抗感染患儿主要感染部位。大多有病原学证据,包括血培养、痰培养、尿培养、分泌物培养等,培养结果主要为多重耐药肺炎克雷伯杆菌、大肠埃希菌。阿米卡星平均剂量为(14.97±1.94)mg/(kg·d),平均给药周期为(9.42±5.06)d。68例(65.4%)使用阿米卡星抗感染治疗后炎症指标和临床症状好转。使用过程中监测其肾功,采用多因素logistic回归分析,结果表明阿米卡星相关暴露变量与发生急性肾损伤之间无显著相关。出院后随访患儿生活中的听力情况,仅1例听力检查未通过,建议人工耳蜗治疗,其余患儿生活中听力无异常。结论:阿米卡星在新生儿病区多用于有多重耐药革兰阴性菌感染的患儿,使用剂量、时长、频次根据患儿疾病情况有差异,使用过程中应监测血药浓度,确保谷浓度及峰浓度在安全范围。其次,在肾毒性方面,阿米卡星相关暴露变量与发生急性肾损伤之间无显著相关。Objective:To analyze the cases who were given amikacin intravenously in the neonatal ward of Children's Hospital of Chongqing Medical University and to summarize the etiological basis,dose,efficacy,ototoxicity,and nephrotoxicity of amikacin for providing guidance for clinical medication of amikacin.Methods:A retrospective study described the clinical features of 104 neonates with amikacin intravenously admitted to the Neonatal Ward of the Children's Hospital of Chongqing Medical University from January 2013 to December 2018,including general information,etiological examination results,main diagnosis,amikacin usage,renal function,and telephone follow-up of their hearing situation after discharge.Results:Totally 104 neonates given amikacin intravenously were included in this study,with an average gestational age of(32±4)weeks,and a median birth weight of 1395.00(1131.25,2190.00)g.Bloodstream infections,respiratory tract infections,intestinal infections,and intracranial infections were the main infection sites of patients treated with amikacin.Most of them had pathogenic evidence,including blood culture,sputum culture,urine culture,secretion culture,etc.The culture results were mainly multidrug-resistant Klebsiella pneumoniae and Escherichia coli.The average dose of amikacin was(14.97±1.94)mg/(kg·d),and the average administration duration was(9.42±5.06)days.A total of 68 cases(65.4%)showed improvement in inflammation and clinical symptoms after treatment with amikacin.The renal function was monitored in use,and multivariate logistic regression analy sis was used.The results showed that there was no significant correlation between amikacin-related exposure variables and the occurrence of acute kidney injury.After discharge,the children's hearing situation was followed up.Only one case failed the hearing test and cochlear implantation was recommended.The remaining children had no abnormal hearing in life.Conclusion:Amikacin is mostly used in neonatal wards for patients with multi-drug resistant gram-negative bacte

关 键 词：阿米卡星 新生儿 耳毒性 肾毒性 

分 类 号：R722.13[医药卫生—儿科]