本文選題：重癥肺炎　切入點：萬古霉素　出處：《臨床兒科雜志》2017年06期 　論文類型：期刊論文

【摘要】：目的探討革蘭陽性球菌重癥肺炎患兒萬古霉素血藥谷濃度的影響因素。方法收集93例革蘭陽性球菌重癥肺炎患兒的一般情況、生化檢查結(jié)果及萬古霉素血藥濃度,回顧分析患兒臨床資料中與萬古霉素血藥谷濃度相關(guān)的因素。結(jié)果在萬古霉素40~60 mg/(kg·d)的給藥方案下,93例革蘭陽性球菌重癥肺炎患兒中萬古霉素血藥谷濃度10 mg/L 54例、10~mg/L 26例、≥20 mg/L 13例,三組間谷氨酸氨基轉(zhuǎn)移酶(ALT)、天門冬氨酸氨基轉(zhuǎn)移酶(AST)、腎小球濾過率(GFR)和谷酰轉(zhuǎn)肽酶(γ-GT)水平差異有統(tǒng)計學(xué)意義(P均0.05),其中10~mg/L組的AST和γ-GT最高,≥20 mg/L組ALT最高而GFR最低。多重線性回歸分析發(fā)現(xiàn),GFR與萬古霉素血藥谷濃度間存在負線性相關(guān)關(guān)系(R~2=0.039,P0.05)。GFR≥90 m L/(min·1.73 m~2)、60≤GFR≤89 m L/(min·1.73 m~2)、30≤GFR≤59 m L/(min·1.73 m~2)組患兒對應(yīng)萬古霉素血藥谷濃度中位數(shù)分別為8.7 mg/L、18.2 mg/L、6.5 mg/L,差異有統(tǒng)計學(xué)意義(P均0.05)。結(jié)論革蘭陽性球菌重癥肺炎患兒萬古霉素血藥谷濃度與GFR水平呈負相關(guān),合并腎功能輕度損害者更易達到萬古霉素目標血藥谷濃度值。臨床上應(yīng)以指南推薦的較低劑量使用萬古霉素,并注意密切監(jiān)測其血藥谷濃度。
[Abstract]:Objective to investigate the influencing factors of serum vancomycin concentration in children with Gram-positive cocci severe pneumonia. Methods 93 cases of Gram-positive cocci severe pneumonia were collected, the results of biochemical examination and the concentration of vancomycin were collected. Results the clinical data of 93 children with severe pneumonia of Gram positive cocci were treated with vancomycin 4060 mg/(kg 路d. Results the serum concentration of vancomycin was 10 mg/L or 10 mg / L in 54 patients with severe pneumonia of Gram positive cocci. There were significant differences in the levels of glutamate aminotransferase (alt), aspartate aminotransferase (AST), glomerular filtration rate (GFR) and glutenyl transpeptidase (緯 -GTase) between the three groups (P < 0.05), and the highest levels of AST and 緯 -GT were found in 10 mg / L group. The ALT of 鈮，

本文編號：1622075