【作者】 方玲； 夏泉； 汪燕燕； 朱猛； 宋帅； 孙旭群；

【Author】 FANG Ling;XIA Quan;WANG Yan-yan;ZHU Meng;SONG Shuai;SUN Xu-qun;The First Affiliated Hospital of Anhui Medical University;Third-Grade Pharmaceutical Chemistry Laboratory of State Administration of Traditional Chinese Medicine;

【机构】 安徽医科大学第一附属医院药剂科； 国家中医药管理局中药化学三级实验室；

【摘要】 目的分析我院万古霉素血药浓度监测结果和临床应用情况,为临床合理用药提供参考。方法回顾性调查我院2016年7月～2017年6月进行万古霉素血药浓度监测的患者信息,统计分析血药浓度、感染部位、肾功能等数据。结果纳入141例患者、256例次万古霉素浓度监测,总平均血药浓度19.22±11.33μg·mL^-1,首次平均浓度18.40±11.88μg·mL^-1,浓度在10～20μg·mL^-1的构成比分别为32.81%、 30.05%,两组无显著性差异。eGFR 75～110mL/（min·1.73m²）组患者万古霉素浓度达标率45.20%,58.73%的肾功能严重受损患者血药浓度高于20μg·mL^-1（eGFR <40mL/（min·1.73m²））,而eGFR>110mL/（min·1.73m²）的患者中,45.24%血药浓度低于10μg·mL^-1。用药前后,5例患者肾损害可能与药物相关。结论我院万古霉素首次与总血药浓度达标率均较低,尤其是肾功能不全或亢进的患者人群,监测结果未能在临床应用中充分发挥作用。应加强血药浓度监测,同时综合患者临床情况,选择适宜的给药方案,实现个体化治疗,提高药物的安全、有效性。更多还原

【Abstract】 OBJECTIVE The monitoring results and clinical application of vancomycin in our hospital were analyzed in order to provide reference for clinical rational drug use. METHODSThe data of vancomycin blood concentration from July 2016 to June 2017 in our hospital were retrospectively investigated, and the data of blood drug concentration, infection site and renal function were statistically analyzed.RESULTS141 patients, 256 cases of vancomycin concentration were monitored.The average tough concentration of vancomycin was 19.22±11.33μg·mL^-1, 32.81% of these case were in the effective range(10-20μg·mL^-1).The first monitoring of average concentration was 18.40±11.88μg·mL^-1, 30.05% of these case were in the effective range. There was no significant difference between these two groups.In patients with estimated glomerular filtration rate（eGFR） 75-110 mL/（min · 1.73 m²）, the effective concentration rate of vancomycin was 45.2%, while 58.73% of patients with severe renal impairment were higher than 20 μg·m^-1（40 mL/（min·1.73 m²））. In patients with eGFR>110 mL/（min·1.73 m²）, 45.24% blood drug concentration is lower than 10 μg·mL^-1. 5 patients with renal impairment may be related to drugs toxicity during the therapy. CONCLUSIONThe compliance rate of vancomycin for the first time and total blood drug concentration in our hospital is low, especially in the population of patients with renal insufficiency or hyperactivity. The blood drug concentration monitoring results did not fully functioning in clinical application so should be strengthened, and the appropriate dosage regimen should be selected to achieve individualized treatment and improve the safety and effectiveness of drugs.更多还原