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目的:分析不同剂量万古霉素对小儿感染耐甲氧西林金黄色葡萄球菌(MRSA)肺炎的治疗效果,并探究最适合的治疗浓度。方法:选取中山市三乡医院2014年1月至6月收治的45例小儿MRSA肺炎患者,随机分为低、中、高剂量组3组,各15例,每次分别应用10、12.5、15 mg/kg的给药浓度,观察患者的血药浓度,临床疗效及MRSA的清除率。结果:45例患儿全部接受血药浓度监测。高剂量组患儿的平均血药浓度显著高于低剂量组和中剂量组患儿,高剂量组患儿的血药浓度达到预计浓度的占比显著高于低剂量组和中剂量组,差异具有统计学意义(P<0.05);不同年龄组的患儿在给予相同剂量的万古霉素时,其血药浓度差异较小,对于患有先天性心脏病及肝功能障碍的患儿,其血药浓度与正常患儿相比,差异均无统计学意义(P>0.05),高剂量组患儿的疗效与MRSA清除率均显著优于对照组,差异具有统计学意义(P<0.05)。结论:对于小儿感染MRSA肺炎的治疗,万古霉素合适的剂量为每次15 mg/kg。
Objective: To analyze the therapeutic effects of different doses of vancomycin on MRSA pneumonia in pediatric patients and explore the most suitable therapeutic concentration. Methods: Forty-five children with MRSA pneumonia admitted from January 2014 to June 2014 in Zhongshan Sanxiang Hospital were randomly divided into 3 groups (low, middle and high dose group), 15 in each group, with 10, 12.5, mg / kg administration concentration, observed the patient’s plasma concentration, clinical efficacy and MRSA clearance rate. Results: All the 45 children received blood concentration monitoring. The average blood concentration in high dose group was significantly higher than that in low dose group and middle dose group, and the proportion of high dose group to the expected concentration was significantly higher than that of low dose group and middle dose group (P <0.05). Children of different age groups had the same difference in blood concentration when given the same dose of vancomycin. For children with congenital heart disease and liver dysfunction, there was a significant difference There was no significant difference between the two groups (P> 0.05). The therapeutic effect and MRSA clearance rate of high dose group were significantly better than those of control group (P <0.05) . Conclusion: The appropriate dose of vancomycin is 15 mg / kg for the treatment of MRSA pneumonia in children.