李俊敏

[摘要] 目的 探讨万古霉素在小儿败血症治疗中的应用价值。方法 方便选取该院在2015年9月—2017年9月间收治的小儿败血症患儿94例进行研究，根据入院前后顺序分成对照组和观察组，分别予以头孢呋辛和万古霉素，进行两组疾病治疗效果的对比。结果 观察组疾病治疗总有效率高于对照组（93.62% vs 74.47%），出现不良反应的概率低于对照组（4.26% vs 21.28%），差异有统计学意义（χ2=6.425，P=0.011;χ2=6.113，P=0.013<0.05）;对照组和观察组治疗前的免疫功能间差异无统计学意义（P>0.05），观察组治疗后免疫球蛋白M水平低于对照组，免疫球蛋白G和自然杀伤细胞活性高于对照组[（0.25±0.04）g/L vs （0.16±0.05）g/L，（12.72±2.35）g/L vs （9.24±1.72）g/L，（50.62±7.24）% vs （34.27±5.72）%]，差异有统计学意义（t=9.636，P=0.000;t=8.192，P=0.000;t=12.148，P=0.000<0.05）。结论 予以小儿败血症患儿万古霉素，可促进临床疗效的提升，也可改善患儿免疫功能，也可降低不良反应发生风险，推广应用价值高。

[关键词] 萬古霉素;小儿败血症;免疫功能;不良反应

[Abstract] Objective To explore the application value of vancomycin in the treatment of pediatric sepsis. Methods A total of 94 pediatric children with sepsis treated in the hospital from September 2015 to September 2017 were convenient selected for study. They were divided into the control group and the observation group according to the order before and after admission， and were treated with cefuroxime and vancomycin. Comparison of treatment effects. Results The total effective rate of disease treatment in the observation group was higher than that in the control group （93.62% vs 74.47%）， and the probability of adverse reactions was lower than that in the control group（4.26% vs 21.28%）. The difference was statistically significant （χ2=6.425， P=0.011; χ2=6.113， P=0.013<0.05）; there was no significant difference in the immune function between the control group and the observation group before treatment （P>0.05）. The level of immunoglobulin M in the observation group was lower than that in the control group and immunoglobulin G and natural killer cell activity were higher than the control group [（0.25±0.04） g/L vs （0.16±0.05） g/L， （12.72±2.35） g/L vs （9.24±1.72） g/L， （50.62±7.24）% vs （34.27±5.72）%]， the difference is statistically significant（t=9.636， P=0.000; t=8.192， P=0.000; t=12.148， P=0.000 <0.05）. Conclusion Vancomycin in children with septicemia can promote the improvement of clinical efficacy， improve the immune function of children， and reduce the risk of adverse reactions.

[Key words] Vancomycin; Septicemia in children; Immune function; Adverse reactions

败血症是常见且严重的重症感染性疾病，多由致病菌进入血液，参与血液循环，在其中生长繁殖，释放毒素引发的全身性感染。小儿群体是该疾病的主要发病对象，起病急、发展快，以突发性高热为主要表现，部分患儿可现有寒战症状，后出现高热症状，体温可达39℃甚至是更高，发热不规则或为持续性发作，身体状况不佳者或营养不良者疾病发作过程中往往无发热症状，多以精神状态不佳为主要表现。发病过程中可有皮疹、斑点、白细胞计数上升、肝脾肿大等表现，革兰阴性杆菌感染者易合并感染性休克，阳性菌感染者可出现病灶迁徙。处理解决不及时，可致使原有疾病进一步发展，引发弥漫性血管内凝血和多脏器功能损伤，甚至危及小儿患者生命安全[1-3]。万古霉素是现阶段广泛应用的抗生素之一，可有效抑制细菌生长繁殖，抗菌活性好，被广泛应用于小儿败血症的治疗中[4]。……