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医院获得性肺炎患者美罗培南血药浓度不达标的危险因素分析
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| 篇名： | 医院获得性肺炎患者美罗培南血药浓度不达标的危险因素分析 |
| TITLE： | Risk factors of substandard drug blood concentration of meropenem in patients with hospital -acquired pneumonia |
| 摘要： | 目的 分析医院获得性肺炎（HAP）患者美罗培南血药浓度不达标的危险因素。方法选择南京医科大学附属苏州医院2020年1月至2021年6月入住重症监护室且行美罗培南稳态血药谷浓度检测的130例HAP患者为研究对象。记录患者的年龄、性别、体质量等病史资料。测定美罗培南稳态血药谷浓度，并确定其靶标。采用单因素和多因素Logistic回归分析法筛选美罗培南稳态血药谷浓度不达标的危险因素，绘制受试者工作特征（ROC）曲线筛选危险因素的警戒值并评估危险因素的预测价值。结果美罗培南稳态血药谷浓度≥2mg/L的有85例，稳态血药谷浓度＜2mg/L的有45例。多因素Logistic回归分析显示，年龄、负平衡量、颅脑损伤为美罗培南稳态血药谷浓度不达标的独立危险因素（P＜0.05）。ROC曲线显示，患者年龄为58岁时，ROC曲线下面积最大（0.744），灵敏度为0.882，特异度为0.556，约登指数为0.438；负平衡量为520.5mL/24h时，ROC曲线下面积达到最大（0.827），灵敏度为0.722，特异度为0.905，约登指数为0.628。颅脑损伤组患者的肌酐清除率显著高于非颅脑损伤组患者、美罗培南稳态血药谷浓度显著低于非颅脑损伤组患者（P＜0.001）。结论HAP患者年龄＜58岁、存在颅脑损伤及负平衡量＞520.5mL/24h时，美罗培南稳态血药谷浓度不达标的风险会增加。 |
| ABSTRACT： | OBJECTIVE To analyze the risk factors of substandard drug blood concentration of meropenem in patients with hospital acquired pneumonia （HAP）. METHODS Totally 130 HAP patients who were admitted to the intensive care unit of Suzhou Hospital Affiliated to Nanjing Medical University from January 2020 to June 2021 and received steady -state blood concentration test of meropenem were selected as the study subjects . The patient ’s age ，sex，body mass and other medical history were recorded . The steady-state blood trough concentration of meropenem was determined and its target was determined . Univariate and multivariate Logistic regression analysis were used to screen the risk factors for the substandard steady -state blood trough concentration of meropenem. The receiver operating characteristic （ROC）curve was drawn to screen the warning value of the risk factors and evaluate the predictive value of the risk factors . RESULTS The steady -state blood trough concentrations of 85 cases were ≥2 mg/L， and those of 45 cases were ＜2 mg/L. Multivariate Logistic regression analysis showed that age ，negative balance and brain injury were independent risk factors for the substandard steady-state blood trough concentration of meropenem （P＜ 0.05）.ROC curve showed that when the patient was 58 years old，the area under the ROC curve was the largest （0.744）， the sensitivity was 0.882，the specificity was 0.556，and the Youden index was 0.438；when the negative balance was 520.5 mL/24 h，the area under the ROC curve reached the maximum （0.827），the sensitivity was 0.722，the specificity was 0.905，and th e Youden index was 0.628. The creatinine clearance rate in the brain injury group was significantly higher than that in the non -brain injury group ，and the steady -state blood trough concentration of meropenem in the brain injury group was significantly lower than that in the non -brain injury group （P＜0.001）. CONCLUSIONS When the HAP patient ’s age is less than 58 years old ，the brain injury and the negative balance is more than 520.5 mL/24 h，the risk of substandard steady -state blood trough concentration of meropenem will increase . |
| 期刊： | 2022年第33卷第19期 |
| 作者： | 石璐，陈芳，鲁广先，段露芬，陆件，庄智伟，徐金慧，许洪涛，吴超，周琴，唐莲 |
| AUTHORS： | |
| 关键字： | 美罗培南；医院获得性肺炎；血药谷浓度；治疗药物监测；肌酐清除率；危险因素 |
| KEYWORDS： | hospital-acquired pneumonia ；blood trough concentration ；therapeutic drug monitoring ；creatinine clearance rate ； |
| 阅读数： | 239 次 |
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