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我院ICU老年感染患者万古霉素血药谷浓度的监测结果分析
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| 篇名： | 我院ICU老年感染患者万古霉素血药谷浓度的监测结果分析 |
| TITLE： | |
| 摘要： | 目的：为万古霉素的临床应用提供参考。方法：收集2013年1月－2017年12月我院重症监护室（ICU）使用万古霉素的老年感染患者的病历资料，对其临床疗效、细菌清除情况、用药安全性及血药谷浓度分布情况进行回顾性分析。结果：该期间我院ICU共有959例老年感染患者接受万古霉素治疗，其中行稳态血药谷浓度监测的有237例（其中肾功能正常者135例，肾功能异常者102例），占24.7％。经万古霉素治疗后，痊愈、显效、进步、无效的患者分别有53、76、36、72例，总有效率为69.6％。共有168例患者送检了临床标本，病原学送检率为70.9％；检出病原菌以耐甲氧西林金黄色葡萄球菌、耐甲氧西林表皮葡萄球菌等为主，细菌清除率为72.0％。237例患者治疗前后肾功能指标比较，差异均无统计学意义（P＞0.05）。135例肾功能正常患者中，有13例用药后出现血肌酐水平异常升高，其中1例伴有皮疹；经停药或减量后症状均有所好转；102例肾功能异常患者用药后均未出现肾功能恶化。237例患者共监测万古霉素血药谷浓度370次，人均1.56次；平均血药谷浓度为（10.4±9.7）mg/L；谷浓度维持在10～20 mg/L范围内的有85例（35.8％），合计121次（32.7％），监测不合格率为67.3％。肾功能正常患者血药谷浓度监测次数、调整用药的比例、血药谷浓度＞20 mg/L的比例均显著低于肾功能异常患者，血药谷浓度为10～15、＞15～20 mg/L的比例均显著高于肾功能异常患者（P＜0.05）。结论：我院ICU老年感染患者监测万古霉素血药浓度的比例不高，且治疗有效率偏低；大部分患者的血药谷浓度不在有效范围内，且不同肾功能状况患者血药谷浓度的分布有差异，肾功能异常患者的万古霉素血药浓度可能更高。临床应积极开展万古霉素血药浓度监测，并根据监测结果和患者个体特征及时调整用药方案，以确保治疗的安全、有效。 |
| ABSTRACT： | OBJECTIVE： To provide reference for clinical use of vancomycin. METHODS： Medical records of elderly infective patients receiving vancomycin were collected from ICU of our hospital during Jan. 2013-Dec. 2017. Clinical efficacy， bacterial clearance， safety， trough blood concentration distribution were analyzed retrospectively. RESULTS： A total of 959 elderly patients received vancomycin in ICU of our hospital. Totally 237 patients （24.7％） received steady trough concentration monitoring （containing 135 patients with normal renal function， 102 patients with abnormal renal function）. After vancomycin treatment， there were 53 cured patients， 73 valid patients， 36 improved patients and 72 invalid patients， with total response rate of 69.6％. Clinical specimens of 168 patients were detected， with detection rate of 70.9％. The pathogens were mainly methicillin-resistant Staphylococcus aureus and methicillin-resistant S. epidermidis， with bacterial clearance rate of 72.0％. There was no statistical significance in renal function indexes of 237 patients before and after treatment （P＞0.05）. Among 135 patients with normal renal function， 13 patients suffered from abnormal increase of Scr， among which one patient also had rash. After drug withdrawal or reduction， all symptoms were improved. Deterioration of renal function was not found in 102 patients with abnormal renal function after administration. The trough concentration of vancomycin was monitored 370 times in 237 patients （1.56 times per capita） with an average of （10.4±9.7） mg/L. The trough concentration kept in the range of 10-20 mg/L in 85 patients （35.8％） and monitored 121 times in total （32.7％）. The failure rate of monitoring was 67.3％. The times of trough concentration monitoring， the proportion of drug adjustment， the proportion of trough concentration ＞20 mg/L in patients with normal renal function were significantly lower than patients with abnormal renal function； the proportion of patients with normal renal function whose trough concentration ranged 10-15 and ＞15-20 mg/L was significantly higher than that of corresponding patients with abnormal renal function （P＜0.05）. CONCLUSIONS： The proportion of vancomycin trough concentration monitoring in ICU elderly infective patients is not high in our hospital and the response rate of treatment is low. The trough concentration of vancomycin in most patients is not within the effective range， and the distribution of trough concentration in patients with different renal function is different. The trough concentration of vancomycin in patients with abnormal renal function may be higher. Vancomycin blood concentration monitoring should be actively carried out in clinical practice， and drug regimens should be adjusted according to the monitoring results and individual characteristics of patients to ensure the safety and effectiveness of treatment. |
| 期刊： | 2018年第29卷第24期 |
| 作者： | 刘素琴，沈国琴 |
| AUTHORS： | LIU Suqin，SHEN Guoqin |
| 关键字： | 重症监护室；老年感染患者；万古霉素；治疗药物监测；血药谷浓度；临床疗效；细菌清除；安全性；肾功能 |
| KEYWORDS： | ICU； Elderly infective patient； Vancomycin； Therapeutic drug monitoring； Trough concentration； Clinical efficacy； Bacterial clearance； Safety； Renal function |
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