本文選題：兒科　切入點(diǎn)：萬(wàn)古霉素　出處：《重慶醫(yī)科大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：隨著萬(wàn)古霉素臨床應(yīng)用的日益廣泛，現(xiàn)已產(chǎn)生了萬(wàn)古霉素耐藥菌株，正確認(rèn)識(shí)并合理應(yīng)用萬(wàn)古霉素具有重要的臨床意義與價(jià)值。本調(diào)查通過(guò)了解我院兒童萬(wàn)古霉素的臨床應(yīng)用情況，分析其用藥現(xiàn)狀及用藥合理性，為進(jìn)一步促進(jìn)萬(wàn)古霉素在兒童臨床合理應(yīng)用提供理論依據(jù)及參考。 方法：回顧性收集我院2012年6月份到2012年11月份6個(gè)月住院患兒的萬(wàn)古霉素用藥臨床資料，包括患兒一般情況、臨床診斷、病原學(xué)檢查、用藥劑量、療程、血藥濃度監(jiān)測(cè)、用藥合理性、藥物不良反應(yīng)等進(jìn)行相關(guān)統(tǒng)計(jì)分析。 結(jié)果：（1）199例使用萬(wàn)古霉素患兒包括兒內(nèi)科患兒150例和兒外科患兒49例。平均住院天數(shù)為78天，最短住院天數(shù)為1天，最長(zhǎng)住院天數(shù)為150天。年齡分布以小于1歲嬰兒為主，占55%，其次為幼兒，占17%。（2）臨床診斷以肺炎及敗血癥多見(jiàn)，占66%。（3）199例患兒中有194例進(jìn)行了病原學(xué)檢查，標(biāo)本主要來(lái)自無(wú)菌腔標(biāo)本，占72.68%。陽(yáng)性標(biāo)本145例，占74.74%，陰性49例，占25.26%。陽(yáng)性標(biāo)本以金黃色葡萄球菌最多見(jiàn)，共35例，，占24.14%，其次為表皮葡萄球菌，共19例，占13.10%。（4）行藥物敏感性實(shí)驗(yàn)的145例標(biāo)本明確有83例對(duì)萬(wàn)古霉素敏感，余未行萬(wàn)古霉素藥敏實(shí)驗(yàn)。（5）每天用萬(wàn)古霉素總劑量最多的為40mg/kg，占49%；用藥頻次最多的為q6h，占54%；199例中有84例行血藥濃度監(jiān)測(cè)。199例病例中有96例聯(lián)合使用抗菌藥物，占48.24%。（6）臨床療效以有效為主，占44.22%，199例中發(fā)生不良反應(yīng)的有6例，占3.02%，主要的不良反應(yīng)為皮疹。 結(jié)論：總體來(lái)講，萬(wàn)古霉素在我院兒科的應(yīng)用基本合理，我院臨床重視萬(wàn)古霉素使用前的病原學(xué)證據(jù)尋找，并根據(jù)病原學(xué)特點(diǎn)開(kāi)展治療，我院對(duì)萬(wàn)古霉素不良反應(yīng)的監(jiān)測(cè)較嚴(yán)密。但同時(shí)我院使用萬(wàn)古霉素也存在不足之處，應(yīng)進(jìn)一步加強(qiáng)用藥前的萬(wàn)古霉素藥敏實(shí)驗(yàn)檢查。萬(wàn)古霉素具有嚴(yán)重的腎、耳毒性，用藥療程要求嚴(yán)格，應(yīng)合理控制萬(wàn)古霉素的用藥療程，并嚴(yán)格掌握聯(lián)合抗生素的應(yīng)用指征。萬(wàn)古霉素的血藥濃度受到多種因素的影響，如疾病的嚴(yán)重程度，肥胖，腎功能等，我院應(yīng)注意萬(wàn)古霉素的初始使用劑量，并監(jiān)測(cè)血藥濃度及時(shí)調(diào)整用藥劑量，同時(shí)應(yīng)嚴(yán)格適應(yīng)癥，進(jìn)一步規(guī)范萬(wàn)古霉素的使用，有助于提高萬(wàn)古霉素的治療效果、合理用藥水平及防范不良反應(yīng)。
[Abstract]:Objective: with the increasing clinical application of vancomycin, vancomycin resistant strains have been produced. The correct understanding and rational application of vancomycin is of great clinical significance and value. Through understanding the clinical application of vancomycin in children in our hospital, the present situation and rationality of vancomycin use are analyzed. To further promote the clinical application of vancomycin in children to provide theoretical basis and reference. Methods: the clinical data of vancomycin used in our hospital from June 2012 to November 2012 were collected retrospectively, including general situation, clinical diagnosis, etiological examination, dosage, course of treatment and monitoring of serum drug concentration. The rationality of drug use and adverse drug reactions were statistically analyzed. Results among 199 cases of vancomycin, 150 cases were children in pediatric medicine and 49 cases in pediatric surgery. The average hospitalization days were 78 days, the shortest hospitalization days were 1 day, and the longest hospitalization days were 150 days. The age distribution was mainly for infants under 1 year old. Pneumonia and septicemia were more common in clinical diagnosis. 194 out of 66.1,199 cases were examined by etiology. The samples were mainly from aseptic cavity, accounting for 72.68.The positive specimens were 145 cases, accounted for 74.74 cases, and negative cases were 49 cases. Staphylococcus aureus was the most common positive specimen, accounting for 24.14, followed by Staphylococcus epidermidis (19 cases). The total dose of vancomycin was 40 mg / kg per day (49%), and the most frequently used vancomycin was Q6 h (84 out of 54199 cases) and 96 of 199 cases (96 cases of combined use of antimicrobial agents). The clinical curative effect was mainly effective, accounting for 6 cases (3.02%) in 199 cases of 44.22 cases. The main adverse reaction was rash. Conclusion: in general, the application of vancomycin in pediatrics of our hospital is basically reasonable. Our hospital attaches importance to the search of etiological evidence before the use of vancomycin, and carries out treatment according to the characteristics of etiology. The adverse reactions of vancomycin were closely monitored in our hospital. However, there were some deficiencies in the use of vancomycin in our hospital, so we should further strengthen the test of vancomycin sensitivity before taking vancomycin. Vancomycin has severe renal and ototoxicity. The course of treatment should be strictly controlled and the indication of application of combined antibiotics should be strictly grasped. The concentration of vancomycin in blood is affected by many factors, such as the severity of disease, obesity, renal function, etc. Our hospital should pay attention to the initial dosage of vancomycin, monitor the concentration of vancomycin and adjust the dosage of vancomycin in time. At the same time, we should strictly regulate the use of vancomycin in order to improve the therapeutic effect of vancomycin. Level of rational use of drugs and prevention of adverse reactions.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R725

【參考文獻(xiàn)】

相關(guān)期刊論文 前5條

1 白東玉;;萬(wàn)古霉素致腎毒性文獻(xiàn)分析[J];河北醫(yī)藥;2012年13期

2 梅清;喻婷;朱玉林;程君;葉英;李家斌;;萬(wàn)古霉素單用及聯(lián)合利福平或磷霉素對(duì)耐甲氧西林金黃色葡萄球菌防耐藥突變濃度的研究[J];中國(guó)藥理學(xué)通報(bào);2011年07期

3 曾小連;;萬(wàn)古霉素在兒科病房中的應(yīng)用調(diào)查[J];中國(guó)醫(yī)藥指南;2012年08期

4 廖愛(ài)芳;慶大霉素產(chǎn)生菌23-18誘變育種研究[J];中國(guó)抗生素雜志;2002年04期

5 鐘倩;;羥乙基淀粉130/0.4氯化鈉注射液與鹽酸萬(wàn)古霉素存在配伍禁忌[J];中國(guó)醫(yī)藥指南;2013年10期

本文編號(hào)：1557239