颅内感染新生儿万古霉素脑脊液渗透率及相关因素分析

目的:监测颅内感染新生儿万古霉素血药浓度、脑脊液浓度、脑脊液渗透率并分析其影响因素,为制定个体化抗感染治疗方案提供依据。方法:收集我院2016年2月至2018年7月因细菌性脑膜炎入住新生儿科并使用万古霉素抗感染治疗的患儿临床资料,监测万古霉素血药浓度和脑脊液浓度,计算其渗透率,应用SPSS17.0统计学软件进行相关因素分析。结果:万古霉素平均血药浓度为11.72(9.54~15.22)mg/L,脑脊液浓度2.32(1.90~3.09)mg/L,渗透率23.02(14.49~33.33)%。万古霉素血药浓度与日龄、矫正胎龄、体质量、血肌酐水平相关(P<0.05);万古霉素脑脊液渗透率与脑脊液白细胞计数和蛋白水平相关(P<0.05)。结论:万古霉素的药动学在新生儿不同个体间差异较大,应根据年龄、体质量和血肌酐水平调整用药剂量,并严密监测血药浓度和脑脊液浓度。

Analysis of Cerebrospinal Fluid Permeability of Vancomycin and Related Factors in Neonates with Intracranial Infection

Objective: To monitor the serum concentration, cerebrospinal fluid concentration, cerebrospinal fluid permeability of vancomycin in neonates with intracranial infection, and to analyze its related factors, so as to provide reference for individualized anti-infection treatment. Methods: Clinical data of neonates with bacterial meningitis and treated by vancomycin in neonatology of our hospital from Feb. 2016 to Jul. 2018 were collected. The serum concentration and cerebrospinal fluid concentration were monitored, and the cerebrospinal fluid permeability was calculated. Related factors were analyzed by SPSS17.0 software. Results: The average vancomycin serum concentration was (13.30±6.79) mg/L, the cerebrospinal fluid concentration was 2.32 (from 1.90 to 3.09) mg/L and the cerebrospinal fluid permeability of vancomycin was 23.02 (from 14.49 to 33.33)%. Vancomycin serum concentration was correlated with days of age, corrected gestational age, body mass and serum creatinine level (P<0.05). Vancomycin cerebrospinal fluid permeability was correlated with cerebrospinal fluid white blood cell count and protein levels (P<0.05). Conclusion: The pharmacokinetics of vancomycin varies among different individuals of neonates. The dosage should be adjusted according to age, body mass and serum creatinine level, the serum concentration and cerebrospinal fluid concentration should be monitored closely