摘要
目的探讨ICU重症感染患儿万古霉素不同用药剂量与血药谷浓度及肾功能损伤的关系。方法收集2018年1月至2018年11月本院重症医学二科收治的使用万古霉素治疗重症感染患儿100例为研究对象,根据给药剂量不同分为高剂量组[15 mg/(kg·次),57例]与低剂量组[10 mg/(kg·次),43例],同时根据患儿肾功能损伤情况分为肾功能正常组(42例)、轻度损伤组(43例)、中度损伤组(15例)。检测患儿血药谷浓度、血清肌酐(Scr)、血清尿素氮(BUN)水平,分析其与肾功能损伤的关系,同时对万古霉素不同剂量治疗效果进行评价。结果高剂量组重症感染患儿治愈率、血药谷浓度均显著高于低剂量组(P<0.05),而达到有效血药谷浓度时间显著短于低剂量组(P<0.05);用药后低剂量组与高剂量组血清Scr、BUN水平均显著降低(P<0.05);轻度损伤组血药谷浓度及达到目标谷浓度比例均显著高于正常组、中度损伤组(P<0.05);而中度损伤组、轻度损伤组万古霉素日剂量较正常组增加(P<0.05),用药疗程较正常组显著降低(P<0.05)。结论万古霉素治疗ICU重症感染患儿时,采用高剂量万古霉素15 mg/(kg·次)方案临床疗效较好,应监测患儿血药谷浓度及肾功能损伤情况进而制定个体化治疗方案。
Objective To investigate the relationships between different doses of vancomycin with blood drug trough concentration and renal dysfunction in children with severe infection in intensive care unit(ICU).Methods 100 children with severe infection treated with vancomycin from January 2018 to November 2018 in theⅡDepartment of Critical Care Medicine of Hunan Children’s Hospital were studied,according to the dosage,they were divided into high-dose group[15 mg/(kg·time),57 cases]and low-dose group[15 mg/(kg·time),43 cases].At the same time,according to the condition of renal dysfunction,children were divided into normal renal function group(42 cases),mild injury group(43 cases),moderate injury group(15 cases).The blood drug trough concentration was measured,and its relationship with serum creatinine(Scr),serum urea nitrogen(BUN),and renal dysfunction was analyzed.At the same time,the therapeutic effects of different doses of vancomycin were evaluated.Results The cure rate and blood drug trough concentration of children with severe infection in high-dose group were significantly higher than those in low-dose group(P<0.05),and the time to reach effective blood drug trough concentration was significantly shorter than that in low-dose group(P<0.05);the levels of serum Scr and BUN in low-dose group and high-dose group were significantly lower than those before treatment(P<0.05);the blood drug trough concentration and the proportion of reaching the target trough concentration in mild injury group were significantly higher than those in normal group and moderate injury group(P<0.05);the dose of vancomycin in mild injury group and moderate injury group was significantly higher than that in normal group(P<0.05),and the course of treatment in mild injury group and moderate injury group was lower than that in normal group(P<0.05).Conclusions The high dose of vancomycin 15 mg/(kg/time)is effective in the treatment of ICU children with severe infection.the blood drug trough concentration and renal dysfunction should be monitored and individualized treatment plan should be formulated.
作者
朱德胜
Zhu Desheng(Department ofⅡCritical Care Medicine,Hunan Children's Hospital,Changsha 410007,China)
出处
《中国医师杂志》
CAS
2020年第3期352-355,360,共5页
Journal of Chinese Physician
基金
湖南省卫生计生委科研计划课题(B20180512)。
关键词
万古霉素
药物剂量
血药浓度
感染
儿童
Vancomycin
Drug dosage
Plasma concentration
Renal dysfunction
Infection
Child
