【作者】 何秋毅； 曾嘉炜； 李佳； 潘敏怡； 陈杰； 洪晓丹； 任斌；

【Author】 HE Qiu-yi;ZENG Jia-wei;LI Jia;PAN Min-yi;CHEN Jie;HONG Xiao-dan;REN-Bin;Department of Pharmacy,The First Affiliated Hospital of Sun Yat-sen University;College of pharmacy,Southern Medical University;

【机构】 中山大学附属第一医院药学部； 南方医科大学药学院；

【摘要】 目的研究ICU脓毒症患者万古霉素血药浓度监测及给药方案调整情况,为临床合理应用万古霉素提供依据。方法回顾性分析本院重症医学科(ICU)2014年7月至2015年1月收治的脓毒症患者,分析患者血药浓度监测情况、治疗前后肾功能指标、30天生存率、给药方案调整情况及相关性分析,P<0.05表示差异具有统计学意义。结果本次研究共纳入患者42例,年龄56.38±17.03;共纳入84例次万古霉素血药浓度检测结果,其中42.85%血药浓度为10~20μg/ml,38.10%血药浓度>20μg/ml;患者血肌酐(SCr)与万古霉素血药浓度正相关,r=0.365,P<0.001,内生肌酐清除率(CCr)与万古霉素血药浓度负相关,r=-0.471,P<0.001;万古霉素血药浓度≥20μg/ml组与万古霉素血药浓度<20μg/ml组相比,SCr、CCr差异具有统计学意义;不同万古霉素血药浓度组患者30天生存率差异无统计学意义;Δ剂量与第一次检测万古霉素血药浓度呈负相关,r=-0.416,P=0.006,Δ剂量与Δ血药浓度呈正相关,r=0.315,P=0.042。结论 ICU脓毒症患者万古霉素血药浓度过高患者所占比例高,患者肾功能与万古霉素血药浓度相关,应加强药物浓度监测下的给药方案调整,提高药物治疗效果,降低不良反应。更多还原

【Abstract】 Objective To investigate therapeutic drug monitoring and dosing regimens of vancomycin in ICU septic patients and provide clinical research data.Methods ICU Patients with sepsis from July 2014 to January 2015 were enrolled in this retrospective study.Vancomycin trough concentrations,serum creatinine(SCr),creatinine clearance(CCr),30-day mortality,dosing regimens were analysis.Results 42 patients were included in this study,age 56.38±17.03.84 vancomycin trough concentrations were analysis,of which 42.85% was 10~20μg/ml,38.10% was above 20μg/ml;regression analysis results showed a positive correlation between SCr and vancomycin trough concentrations,r=0.365,P<0.001;CCr was negatively correlated with vancomycin trough concentrations,r=-0.471,P<0.001;all cases were divided into two groups according to vancomycin trough concentrations,vancomycin trough concentration ≥20μg/ml group and <20μg/ml group,significant differences were detected between groups for SCr and CCr respectively;no obvious differences were detected for 30-day mortality;regression analysis showed negative correlation between ΔDosing and vancomycin concentrations(1 st detection),and a positive regression between ΔDosing and Δconcentration.Conclusions Vancomycin troughconcentrations were frequently exceeded in ICU septic patients.Vancomycin trough concentrations were correlated with SCr and CCr.Trough concentration guided therapeutic drug monitoring and dosing regimens should be strengthened to improve therapeutic outcome and side effect.更多还原