| 摘要: |
| 目的：探讨万古霉素与利奈唑胺治疗革兰阳性菌败血症患儿的临床价值。方法：回顾性分析2011年1月至2016年6月我院收治的革兰阳性菌败血症患儿的临床资料，分为万古霉素组和利奈唑胺组，采用倾向匹配分析法匹配，按照谷浓度分布情况将万古霉素组分为3个亚组：Ⅰ组（谷浓度<10 mg/L）、Ⅱ组（谷浓度：10~20 mg/L）和Ⅲ组（谷浓度>20 mg/L）。比较各组的临床有效率、革兰阳性菌清除率及相关实验室生化指标。结果：成功匹配两组患儿各120例，万古霉素组和利奈唑胺组的临床总有效率及细菌清除率比较差异均无统计学意义（P均>0.05）。Ⅱ组的临床有效率为94.4%，高于Ⅰ组的78.7%，差异有统计学意义（χ2＝5.538，P<0.05）。万古霉素组用药后的总胆红素为34.4（14.8，91.2）µmol/L，明显低于利奈唑胺组的53.2（27.2，121.4）µmol/L，差异有统计学意义（Z=2.124，P<0.05）；万古霉素组用药后的血小板计数为304.2（196.8，418.2）×109/L，明显高于利奈唑胺组的194.5（94.2，283.4）×109/L，差异有统计学意义（Z=-5.368，P<0.001）。利奈唑胺组血小板减少症的发生率为13.4%（29/217）。结论：对于治疗新生儿革兰阳性菌败血症，万古霉素和利奈唑胺的疗效相当，利奈唑胺会影响血小板计数及胆红素水平，而万古霉素的临床疗效与谷浓度相关。 |
| 关键词: 万古霉素 利奈唑胺 新生儿 革兰阳性菌 败血症 感染 |
| DOI：doi:10.13407/j.cnki.jpp.1672-108X.2018.11.003 |
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| 基金项目: |
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| Comparison of Vancomycin and Linezolid in the Treatment of Gram-Positive Bacterial Septicemia and the Effects on Bilirubin and Platelets |
| Zhang Li |
| (Pingmei Shenma Medical Group General Hospital, Henan Pingdingshan 467000, China) |
| Abstract: |
| Objective: To investigate the clinical value of vancomycin and linezolid in the treatment of gram-positive bacterial septicemia. Methods: Retrospective analysis was conducted on clinical data of 333 neborns with gram-positive bacterial septicemia admitted into our hospital from Jan. 2011 to Jun. 2016, all patients were divided into vancomycin group and linezolid group via different treatment regimen, the trend matching analysis method was used, and the vancomycin group was divided into 3 subgroups according to the valley concentration distribution: group I (valley concentration <10 mg/L), group II (valley concentration: 10~20 mg/L) and group III (valley concentration >20 mg/L). The clinical efficiency, gram-positive bacterial clearance rate and related laboratory biochemical indicators were compared. Results: 120 children were successfully matched in each group. There was no significant difference in the clinical total effective rate and bacterial clearance rate between vancomycin group and linezolid group (P>0.05). The clinical effective rate of group II was 94.4%, higher than 78.7% of group I, the difference was statistically significant (χ2=5.538, P<0.05). The total bilirubin of vancomycin group after administration was 34.4 (14.8, 91.2) μmol/L, significantly lower than that of linezolid group 53.2 (27.2, 121.4) μmol/L, the difference was statistically significant (Z=2.124, P<0.05). The platelet count of vancomycin group after administration was 304.2 (196.8, 418.2)×109/L, significantly higher than that of linezolid group 194.5 (94.2, 283.4)×109/L, the difference was statistically significant (Z=-5.368, P<0.001). The incidence of thrombocytopenia in linezolid group was 13.4% (29/217). Conclusion: The efficacy of vancomycin and linezolid in the treatment of neonatal gram-positive bacterial sepsis was comparable. Linezolid can affect the platelet count and bilirubin levels, while the clinical efficacy of vancomycin is correlated with valley concentration. |
| Key words: vancomycin linezolid newborns gram positive bacterial septicemia infection |
