万古霉素治疗新生儿败血症的血药浓度监测与疗效  

Blood concentration monitoring and efficacy analysis of vancomycin for neonatal sepsis

作　　者：陈桂兰 游金兵 张雷 汤琼瑶 陈作武 CHEN Gui-lan;YOU Jin-bing;ZHANG Lei;TANG Qiong-yao;CHEN Zuo-wu(The First People's Hospital of Jiangria District,Wuhan,Hubei 430200,China;不详)

机构地区：[1]武汉市江夏区第一人民医院儿科,湖北武汉430200 [2]湖北省妇幼保健院儿科,湖北武汉430200

出　　处：《中华医院感染学杂志》2022年第7期1086-1090,共5页Chinese Journal of Nosocomiology

基　　金：湖北省科研基金资助项目(20190171)。

摘　　要：目的 探讨新生儿败血症病原菌特征,并分析血药浓度监测下万古霉素治疗的疗效,为临床安全用药提供参考。方法 选取2018年1月-2020年12月武汉市江夏区第一人民医院儿科采用万古霉素治疗并进行血药浓度监测的80例败血症新生儿,进行病原菌培养与鉴定,万古霉素给药剂量为10~15 mg/kg,后续根据血药浓度监测结果调整剂量。评价临床疗效,外周血炎症指标水平变化,药物不良反应。结果 共检出病原菌92株,其中革兰阳性菌80株,革兰阴性菌12株。药敏试验显示80株革兰阳性菌对万古霉素敏感率为100.00%。初次监测血药浓度中,仅有25例(31.25%)达到血药浓度最佳推荐值。调整用药剂量后,有52例(65.00%)达到血药浓度最佳推荐值。痊愈51例(63.75%),显效14例(17.50%),有效12例(15.00%),无效死亡3例(3.75%),总有效率为96.25%。相比给药前,患儿给药后的白细胞计数(WBC)、中性粒细胞/淋巴细胞比值(NLR)、超敏C反应蛋白(hs-CRP)、降钙素原(PCT)、白细胞介素-8(IL-8)、血清淀粉样蛋白A(SAA)、巨噬细胞炎症蛋白-2(MIP-2)、高迁移率族蛋白B1(HMGB1)水平下降(P<0.05)。治疗期间发生皮疹6例(7.50%),静脉炎4例(5.00%),无明显耳毒性。结论 万古霉素治疗革兰阳性菌感染的新生儿败血症疗效良好,炎症指标明显下降,对肝肾功能基本无影响。为保障用药安全性和有效性,有必要进行血药浓度监测,适当调整用药剂量。OBJECTIVE To investigate the characteristics of pathogenic bacteria in neonatal sepsis and analyze the curative effect of vancomycin under blood concentration monitoring, in order to provide reference for clinical safe medication. METHODS From Jan 2018 to Dec 2020, 80 neonates with sepsis treated with vancomycin under blood drug concentration monitoring in the First People′s Hospital of Jiangxia District in Wuhan were recruited. Specimens from these patients were cultured for pathogen identification. The initial dosage of vancomycin was 10~15 mg/kg, which can be adjusted according to the results of blood concentration monitoring. The clinical effects, changes in peripheral blood inflammation factors, and adverse drug reactions were evaluated. RESULTS A total of 92 strains were detected, including 80 strains of Gram-positive bacteria and 12 strains of Gram-negative bacteria. Drug sensitivity test showed that 80 strains of Gram-positive bacteria were totally sensitive to vancomycin. After the initial monitoring of blood drug concentration, only 25 cases(31.25%) reached the best recommended drug blood concentration. After the dosage being adjusted, 52 cases(65.00%) reached the best recommended drug blood concentration. 51 cases were cured(63.75%), 14 cases were markedly effective(17.50%), 12 cases were effective(15.00%), and 3 cases died(3.75%), with a total effective rate of 96.25%. After administration, white blood cell count(WBC), neutrophil to lymphocyte ratio(NLR), high sensitivity C-reactive protein(hs-CRP), procalcitonin(PCT), interleukin-8(IL-8), serum amyloid A(SAA), macrophage inflammatory protein-2(MIP-2) and high mobility group protein B1(HMGB1) decreased significantly(P<0.05). During treatment, 6 cases(7.50%) had skin rashes, 4 cases(5.00%) had phlebitis, and no patient had obvious toxic effect on liver and kidney function. CONCLUSION Vancomycin is effective in the treatment of neonatal sepsis caused by Gram-positive bacterial infection. The inflammatory index decreases significantly, and there is no

关 键 词：新生儿败血症 万古霉素 血药浓度监测 疗效 药敏试验 

分 类 号：R722.131[医药卫生—儿科]