临床药师参与新生儿万古霉素治疗药物监测的临床实践

Clinical Practice of Clinical Pharmacists Participating in Vancomycin Therapeutic Drug Monitoring for Neonates

关键词:  临床药师  万古霉素  新生儿  治疗药物监测

Key words:  clinical pharmacists  vancomycin  neonate  therapeutic drug monitoring

摘要:

目的 探讨临床药师在参与新生儿万古霉素治疗药物监测（therapeutic drug monitoring，TDM）临床实践中发挥的作用，为医师调整给药方案提供参考。方法 采用回顾性分析方法，收集符合条件的新生儿31例，对其一般情况、病原学检查、血药浓度监测结果、影响血药谷浓度的因素、药物疗效及药品不良反应（adverse drug reaction，ADR）等结果进行统计分析。结果 31例患儿中，新生儿脓毒血症占46.34%；病原学检查88.00%为革兰阳性菌，其中多重耐药菌占77.27%。初次血药谷浓度监测范围在10~20 μg·mL^-1的患儿仅占32.26%，医师采纳临床药师干预建议后谷浓度的达标率提高至83.33%（P<0.05）；给药间隔与血药谷浓度呈负相关（P<0.05）。本次研究万古霉素治疗有效率80.65%，且未发生万古霉素相关ADR。结论 万古霉素在TDM下治疗由革兰阳性菌引起的新生儿重症感染疗效确切，但经验性用药后血药谷浓度达标率低，医师采纳临床药师干预建议、减少给药间隔可显著提高血药谷浓度，为医师调整给药方案提供了参考。

Abstract:

OBJECTIVE To investigate the role of clinical pharmacists in the clinical practice of vancomycin therapeutic drug monitoring(TDM) for neonates, and provide reference for physicians to adjust the drug administrations. METHODS Thirty one neonates who met the requirements were collected by retrospective analysis. The general conditions, pathogen examinations, results of TDM, influence factors of vancomycin blood drug valley concentrations, clinical efficacy and adverse drug reactions(ADR) were statistically analyzed. RESULTS Among 31 patients, neonatal sepsis accounted for 46.34% in clinical diagnosis; gram-positive bacteria accounted for 88.00% of all the pathogenic examinations, and multi-drug resistant gram-positive bacteria accounted for 77.27%. Only 32.26% cases were monitored within the range of 10-20 μg·mL^-1 in initial blood drug valley concentrations. The compliance rate of vancomycin blood drug valley concentrations could be significantly increased to 83.33% by physicians adopting the clinical pharmacists' intervention suggestions(P<0.05). There was a negative correlation between administration interval and the blood drug valley concentrations(P<0.05). The effective rate of vancomycin was 80.65%, and there was no vancomycin-related ADR occurred in this study. CONCLUSION Vancomycin is effective in treating severe infections caused by gram-positive bacteria in neonates under TDM, however the compliance rates of vancomycin blood drug valley concentrations are low after experiential medication. Physicians' adoption of intervention suggestions from clinical pharmacists and reduction of administration interval can significantly increase vancomycin blood drug valley concentrations, which provide a reference for physicians to adjust the dosage regimen.