| 周冉,方焱,苏丹.某三甲医院危重症病人万古霉素血药浓度监测与临床用药 87例分析[J].安徽医药,2020,24(4):805-810. |
| 某三甲医院危重症病人万古霉素血药浓度监测与临床用药 87例分析 |
| Vancomycin serum concentration monitoring and clinicalanalysis of 87 critically ill patients in a three grade hospital |
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| DOI：10.3969/j.issn.1009?6469.2020.04.042 |
| 中文关键词: 重症监护 万古霉素 血药浓度 药物监测 急性肾损伤 肌酸酐 肌酐清除率 |
| 英文关键词: Intensive care Vancomycin Plasma concentration Drug monitoring Acute kidney injury Creatinine Creatinine clearance |
| 基金项目:中华医学会临床药学分会吴阶平医学基金会科研基金项目( LCYX?Q009) |
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| 中文摘要: |
| 目的通过分析危重症病人万古霉素血药浓度监测结果，为临床合理用药提供参考。方法采用化学发光法( CIMA)测定万古霉素血药浓度，对 2016年 1月至 2018年 12月期间中国科学技术大学附属第一医院 87例病人共进行 190例次万古霉素血药浓度监测，对万古霉素的监测结果及用药信息进行统计分析。结果 87例病人共监测血药浓度 190次，血药浓度( 24.48± 18.65)μg/mL，在治疗窗的占 35.3%，其中首次监测浓度在治疗窗内的仅占 26.67%；18～60岁组、 60～75岁组以及＞ 75岁组病人血药浓度均值均超出治疗窗；肾功能下降组病人血药浓度［(21.84±19.86)μg/mL、(34.44±22.26)μg/mL、(36.14±20.33)μg/ mL］显著高于肾功能正常组［(13.04±8.09)μg/mL］差异有统计学意义( P＜0.05)；用药前后，肾功能正常组的尿素氮［(7.42± 2.47)比( 11.16±9.44)μmol/L］和肾功能轻度下降组的肌，酐清除率［(75.98±6.72)比( 111.43±60.31)mL/min］的差异有统计学意义(P＜0.05)肾功能中度下降组和肾功能重度下降组肾功能指标均差异无统计学意义( P＞0.05)；此外， 87例病人中急性肾损伤(AKI)的发生，率为 21.13%，肾功能亢进( ARC)的发生率为 18.31%。结论万古霉素药动学个体差异较大，临床应加强危重症病人万古霉素血药浓度的监测，结合病人个体情况，施行个体化用药；此外，在危重症病人中，应尽早识别 AKI及 ARC病人，根 |
| 英文摘要: |
| Objective To analyze the Vancomycin blood concentration test results in critically ill patients to provide a reference forclinical rational drug use.Methods A total of 190 times of Vancomycin blood concentration monitoring by chemiluminescence(CIMA)method were performed on 87 patients in The First Affiliated Hospital of University of Science and Technology of Chinafrom January 2016 to December 2018，and the monitoring results and medication information of Vancomycin were statistically ana? lyzed.Results The blood concentration of 87 patients was monitored 190 times，and the blood concentration was(24.48±18.65) μg/mL，accounting for 35.3% in the therapeutic scope，and the results of first monitoring within the therapeutic scope accounted for 26.67%；the mean trough concentrations of patients aged 18～60 years，61～75 years and＞75 years exceeded therapeutic scope； the trough concentration in the group with decreased renal function［(21.84±19.86)，(34.44±22.26)，(36.14±20.33)μg/mL］was sig? nificantly higher than(13.04±8.09)μg/mL of the group with normal renal function，and the difference was statistically significant(P＜0.05)； before and after Vancomycin administration，the urea nitrogen in patients with normal renal function［( 7.42±2.47)vs.(11.16±9.44)μmol/L］and creatinine clearance in patients with mildly decreased renal function［(75.98±6.72)vs.(111.43±60.31) mL/min］weresignificantly different(P＜0.05)； there was no significant difference in renal function index between patients withmoderately decreased renal function and patients with severely decreased renal function(P＞0.05).Besides，the incidence of acute kidney injury(AKI)was 21.13% in 87patients，and the incidence of augmented renal clearance(ARC)was 18.31%.Conclusions There is a large difference in the pharmacokinetics of Vancomycin.The clinical monitoring of Vancomycin blood concentration incritically ill patients should be strengthened with the patient’s condition，and individualized medication should be implemented in accordance with individual patient conditions.In addition，patients with AKI and ARC in critically ill patientsshould be identified as early as possible，the dose of Vancomycin is adjusted according to its renal function and blood concentration，making clinical medi?cation safer，more effective，and more economic. |
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