【摘要】 目的为临床应用万古霉素治疗感染性心内膜炎提供合理安全的给药方案。方法回顾性分析了2014年1月1日至2018年12月31日本院心血管内外科诊断为感染性心内膜炎(infective endocarditis,IE)且进行了万古霉素血药浓度监测的39例患者的临床资料、血药浓度监测报告,以及血药浓度超过警戒值患者用药前后肾功能指标[血肌酐(serum creatinine,Scr)、肌酐清除率(creatinine clearance rate,CCR)、血尿素氮(blood urea nitrogen,BUN)、半胱氨酸蛋白酶抑制剂C(cystatin C,CysC)]的变化,并评价万古霉素用药合理性。结果万古霉素平均使用的日剂量(1.81±0.84)g;平均使用疗程(25.9±17.7)d。平均联合药物(1.2±0.6)种;39例患者中21例患者多次(≥2次)监测了万古霉素血药浓度,共计监测93例次;首次监测血药浓度达到治疗窗(15～20mg/L)的有14例(占总体监测例次的15.1%),总体监测万古霉素血药浓度达治疗窗的有34例次(36.6%)。万古霉素日剂量小于2g有18例次,血药浓度的平均值为(19.83±4.12)mg/L;万古霉素日剂量为2g的病例数有29例次,其血药浓度平均值为(18.47±2.80)mg/L;万古霉素日剂量大于2g的病例数为7例次,血药浓度平均值为(27.33±3.95)mg/L。其中大于65岁的老年患者的万古霉素日剂量主要为≤2g。12例患者血药浓度达警戒值(>25g/ml)以上,有10例患者用药前后曾行检查肾功能,其中CCR在用药前与血药浓度达到危机值后的差异具有统计学意义(P=0.02),而Scr、BUN、CysC的改变则差异无统计学意义。万古霉素使用不合理2例(5.2%)。发生不良反应5例(共6例次)。结论在治疗IE过程中万古霉素血药浓度监测次数的增多有益于观察血药浓度是否达到治疗窗,且大于65岁的老年患者日剂量宜小于2g;警戒值的报告对安全用药有一定的保障作用。更多还原

【Abstract】 Objective To provide a reasonable and safe drug delivery plan for the clinical application of vancomycin in the treatment of infection endocarditis (IE).Methods A retrospective analysis was performed on 39 cases of IE from January 1,2014 to December 31,2018 in our hospital undergoing vancomycin blood concentration monitoring to evaluate the rational use of vancomycin.We analyzed the clinical data,blood concentration monitoring report and renal function indicators before and after medication including serum creatinine (Scr),creatinine clearance rate (CCR),blood urea nitrogen (BUN),cysteine protease inhibitor and the changes of cystatin C (CysC) in patients whose drug concentration exceeds the alert value.Results The average daily dose of vancomycin was (1.81±0.84) g;the average treatment course was (25.9±17.7) days;the average types of combined drug were (1.2±0.6).The blood concentration of vancomycin in 21 of the 39 patients was monitored for multiple times (≥2 times),and a total of 93 cases were monitored.The blood concentration of the first monitoring reached the therapeutic window (15-20mg/L) in 14 cases (accounting for 15.1%),and the overall monitoring of vancomycin blood concentration reached the therapeutic window in 34 cases (accounting for 36.6%).There were 18 cases of daily vancomycin dose less than 2g,and the average blood concentration was (19.83±4.12) mg/L.There were 29 cases of daily vancomycin dose of 2g,and the average blood concentration was (18.47±2.80) mg/L.Daily vancomycin dose of 7 cases was greater than 2g,and the average blood concentration was (27.33±3.95) mg/L.Among them,the daily dose of vancomycin for elderly patients over 65 years old was mainly≤2g.The blood drug concentration of 12 patients reached the alert value (>25g/ml) and 10 patients had renal function examination before and after the drug use.Among them,the difference of CCR before medication and after the blood drug concentration reached the crisis value was statistically significant (P=0.02),while the changes of Scr,BUN and CysC were not statistically significant.5.2% (2/39) cases were considered as unreasonable use of vancomycin and adverse reactions occurred in 5 patients (6 cases).Conclusion During the treatment of IE,increased monitoring frequency is beneficial to observe whether the blood drug concentration reaches the therapeutic window,and the daily dose of patients older than 65 years should be less than 2g.The report of the alert value has a certain protective effect on safe medication.更多还原