【作者】 曾嘉炜； 高翔； 潘敏怡； 何秋毅； 吴海燕； 陈杰； 陈孝；

【Author】 Zeng Jiawei;Gao Xiang;Pan Minyi;He qiuyi;Wu haiyan;Chen Jie;Chen xiao;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】 目的回顾我院2013~2014年外科重症监护室(SICU)脓毒症患者持续肾替代治疗下(CRRT)万古霉素血药浓度情况,分析CRRT下脓毒血症患者万古霉素的用药情况。方法回顾性分析我院2013年~2014年SICU收治的CRRT状态下使用万古霉素治疗脓毒症的患者63例,分析CRRT起始治疗后患者万古霉素血药浓度情况及万古霉素用药情况。结果本次研究共纳入病例63例(其中男性46人,55.4±18.3岁,女性17人,57.9±16.1岁),患者年龄56.1±17.6岁,APACHE II评分21[17-25]、SOFA评分11[9-14]、SAPS评分41[31-56.5];万古霉素用量为负荷剂量1.94±0.62g/d,维持剂量(Day1)1.8±0.6g/d;首次测量万古霉素血药浓度为(Day1)19.5±9.8μg/m L。首次测量万古霉素血药浓度时,15.9%患者万古霉素血药浓度在正常范围(15~20μg/m L),36.5%患者万古霉素血药浓度偏低(<15μg/m L),47.6%患者血药浓度偏高(>20μg/m L)。结论 SICU脓毒症患者血药浓度尚未控制在理想区间,临床药师亟需加强个体化给药方案设计,提高药物治疗效果,减轻药物不良反应。更多还原

【Abstract】 Objective:To analyze trough serum concentrations and vancomycin regimens in septic patients receiving continuous renal replacement therapy(CRRT) insurgical intensive care unit(SICU).Methods:A retrospective study was undertaken to analyze dosage regimens and trough serum concentrations of vancomycin in septic patients receiving CRRT.63 septic patients on vancomycin receiving CRRT,admitted to SICU during 2013 and 2014,were included.Results:Of all 63 patients(46 male,17 female),the average age was 56.1±17.6 years.The median score [Interquartile range] of APACHE II,SOFA and SAPS was 21[17-25],11[9-14] and 41[31-56.5],respectively.The loading dosage was 1.94±0.62 g/d and maintenance dose(Day 1) was1.8±0.6 g/d,while the trough level of vancomycin was 19.5±9.8μg/m L in Day 1,only 15.9% of patients achieved the adequate level(15~20μg/m L),36.5% of patients had insufficient levels(<15μg/m L),47.6% of patients had excessive levels(>20μg/m L).Concluisons:The vacomycin levels of septic patients receiving CRRT in SICU did not achieve ideal range.Clinical pharmacist should provide individualizing vancomycin dosage regimens for patients receiving CRRT.更多还原