大剂量地西泮治疗新生儿破伤风血药浓度监测分析_临床医学论文.docVIP

大剂量地西泮治疗新生儿破伤风血药浓度监测分析_临床医学论文 大剂量地西泮治疗新生儿破伤风血药浓度监测分析_临床医学论文 作者：阳利龙，银雪花，祝文兵，何周康 【摘要】 目的：对大剂量地西泮治疗新生儿破伤风血药浓度监测结果进行分析。方法：2003年至2008年收治的13例新生儿破伤风病例予以大剂量地西泮为主的治疗，地西泮开始时3～5 mg/（kg·d）鼻饲，每2～4 h给药1次，然后根据患儿抽搐情况逐渐增加至7.5～18 mg/（kg·d），每2～4 h给药1次，抽搐好转后逐渐减量至每次0.25～1 mg/kg的地西泮鼻饲，每3～12 h给药1次，直至停药。在大剂量地西泮治疗过程中的不同时间用高效液相色谱法监测地西泮血药浓度。结果：13例患儿全部治愈。血药浓度范围为279.2～6 493.5 ng/mL，地西泮剂量与血药浓度有一定的相关性；在治疗过程中地西泮血药浓度在1 000～3 000 ng/mL范围内治疗效果较好。结论：可以通过血药浓度监测结果及临床观察相结合作为新生儿破伤风治疗过程中地西泮加减剂量的主要依据。 【关键词】 地西泮；大剂量；新生儿；破伤风；血药浓度 ［Abstract］ Objective: To analyse the monitoring result of the blood concentration of neonatal tetanus treated with large dose diazepam. Methods:13 neonates hospitalized from 2003 to 2008 were given the curative scheme mainly with large dose diazepam. Diazepam was administrated as follow: first 3～5 mg/(kg·d), once every 2～4 hours by nasal feeding, and then the dosage increased to 7.5～18 mg/(kg·d) once every 2～4 hours according to the condition of convulsion seizure, after convulsion seizure got better, the dosage decreased to 0.25～1 mg/kg once every 3～12 hours till the administration stopped. While diazepam was used in large dose, blood concentration was monitorred by high performance liquid chromatography in different times.Results: All 13 cases were cured. The range of blood concentration of diazepam was 279.2～6,493.5 ng/mL. The dosage of diazepam correlated with its blood concentration to some extent and the blood concentration from 1,000 to 3,000 ng/mL was the recommended range for treatment. Conclusions: In therapy of neonatal tetanus, the dosage of diazepam should be increased or decreased according to the monitoring result of blood concentration and clinical observation. ［Key words］ Diazepam; Large dosage; Neonatal; Tetanus; Blood concentration 新生儿破伤风是一种主要经脐部感染破伤风杆菌引起的急性严重感染性疾病，一般有旧法接生史，并发症较多，对新生儿威胁较大，病死率极高。在新生儿破伤风的治疗中，解痉是治疗中最重要的环节，而地西泮（安定）是一种较理想的解痉药物，临床上已经广泛应用。地西泮的常规剂量及大剂量治疗新生儿破伤风在疗效方面有着明显的差异，这已被临床所证实。同时大剂量地西泮治疗新生儿破伤风已在很多医院广泛应用。但选择地西泮剂量时没有具体量化指标，只能根据临床观察加减剂量，具有一定的局限性。剂量过小，