本文選題：萬古霉素　切入點：兒科嚴(yán)重膿毒癥　出處：《浙江大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

【摘要】：研究背景：萬古霉素屬糖肽類抗菌藥物,抑制細(xì)菌細(xì)胞壁的合成。近年來,由于抗生素在臨床的廣泛應(yīng)用,其中以耐甲氧西林金黃色葡萄球菌(MRSA)、耐甲氧西林表皮葡萄球菌(MRSE)日漸增多,萬古霉素作為重癥G+菌感染的首選治療藥物,再次將其推到了抗感染治療的前沿。但萬古霉素的治療指數(shù)窄,個體差異大,影響因素多,且耳、腎毒性大,因此對患者進行藥物濃度監(jiān)測尤為重要。目的：通過萬古霉素不同給藥劑量及方法分析對血藥谷濃度及治療嚴(yán)重膿毒癥臨床療效的影響。方法：采用前瞻性研究方法,將2013年5月-2015年11月浙江大學(xué)兒童醫(yī)院PICU52例確診革蘭氏陽性菌感染兒童嚴(yán)重膿毒癥患兒分為3組：A組18例萬古霉素15mg/kg/次(q8h),平均年齡為3.40±2.11歲,平均體重13.15±10.13Kg,性別比男：女5：4；B組20例萬古霉素首劑30mg/kg后15mg/kg/次(q8h),平均年齡為3.02±2.09歲,平均體重14.27±12.16Kg,性別比男：女11：9；C組14例萬古霉素15mg/kg/次(q6h)平均年齡為3.03±2.02歲,平均體重13.78士11.22Kg,性別比男：女1：1。三組在年齡、性別和體重方面沒有統(tǒng)計學(xué)差異。萬古霉素每次給藥時間均超過1h。分別于用藥4次后、3天、7天于用藥前30 min抽血檢驗,通過酶放大免疫分析法(Emit)測定血液萬古霉素谷濃度。用藥前查體溫、血常規(guī)、雙份血培養(yǎng)、CRP、PCT、肝腎功能,用藥后3天、7天復(fù)查(5天復(fù)查血培養(yǎng))。本課題所有內(nèi)容均告知患兒監(jiān)護人,并得到其書面知情同意。課題研究方案經(jīng)過浙江大學(xué)醫(yī)學(xué)院附屬兒童醫(yī)院安全委員會討論,并取得其許可。結(jié)果：B組和C組用藥4次和3天、7天達有效谷濃度的比例明顯高于A組,有統(tǒng)計學(xué)意義(P0.05)。B和C兩組血培養(yǎng)轉(zhuǎn)陰率、白細(xì)胞下降率、體溫、PCT、CRP下降均明顯早于A組,有統(tǒng)計學(xué)意義(P0.05)。肝腎功能變化比較均無統(tǒng)計學(xué)意義(P0.05)。結(jié)論：通過本文研究提示使用萬古霉素藥物劑量首劑30mg/kg后15mg/kg/次(q8h)和15mg/kg/次(q6h)比15mg/kg/次(q8h)達有效谷濃度時間早、且療效優(yōu),同時首劑30mg/kg后15mg/kg/次(q8h)療效略優(yōu)于15mg/kg/次(q6h)。提示萬古霉素谷濃度維持在10-20mg/L谷濃度區(qū)間,其臨床療效明顯,且無明顯肝腎功能損害等毒副作用的發(fā)生。
[Abstract]:Background: vancomycin is a glycopeptide antimicrobial agent that inhibits the synthesis of bacterial cell wall. Among them, more and more methicillin-resistant Staphylococcus aureus and methicillin-resistant Staphylococcus epidermidis were used. Vancomycin was the first choice for the treatment of severe G infection. But vancomycin's treatment index is narrow, individual difference is large, influence factor is many, and ototoxicity is great. Therefore, it is very important to monitor the drug concentration in patients. Objective: to analyze the effects of different doses and methods of vancomycin on serum drug concentration and clinical efficacy in the treatment of severe sepsis. From May 2013 to November 2015, PICU52 patients with severe sepsis with Gram-positive bacteria infection were divided into 3 groups: group A: 18 patients with vancomycin 15mg / kg / kg, mean age 3.40 鹵2.11 years. The average body weight was 13.15 鹵10.13 kg / kg, male: female: group B: female: group B: vancomycin 15 mg / kg after 30 mg / kg, mean age was 3.02 鹵2.09 years old, average weight was 14.27 鹵12.16 kg, male: female: female 11: 9C group: 14 cases of vancomycin 15mg / kg / kg Q6h) mean age was 3.03 鹵2.02 years old. The average body weight was 13.78 鹵11.22 kg / g, male: female 1: 1.There was no significant difference in age, sex and body weight among the three groups. Vancomycin was administered for more than 1 hour each time. The concentration of vancomycin in blood was measured by enzyme amplified immunoassay (Emitt). Body temperature, blood routine, double blood culture, CRP PCT, liver and kidney function were examined before medication. All contents of this study were informed to the guardian of the child and their written informed consent was obtained. The project was discussed by the Safety Committee of Children's Hospital affiliated to Zhejiang University Medical College. Results the ratio of effective valley concentration in group B and group C was significantly higher than that in group A for 4 times and 3 days. There was significant difference between group A and group A in the negative rate of blood culture, the decrease rate of white blood cells, the decrease of body temperature and the decrease of serum PCTTnC-reactive protein in group C and group B were significantly earlier than those in group A, and the blood culture negative rate of group B and group C were significantly earlier than those in group A. There was no significant difference in the changes of liver and kidney function between the two groups. Conclusion: the results of this study suggest that the effective valley concentration of vancomycin was earlier than that of 15 mg / kg Q8h after the first dose of vancomycin was 30 mg / kg) and 15 mg / kg / time Q8h), and the effect was better than that of 15 mg / kg Q8h. At the same time, 15 mg / kg after the first dose of 30 mg / kg, the curative effect was slightly better than that of 15 mg / kg / L Q6h. It suggested that the concentration of vancomycin was maintained in the range of 10-20 mg / L valley concentration, and the clinical efficacy was obvious, and there were no obvious side effects such as liver and kidney function damage.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R720.597

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